Provider Demographics
NPI:1487652046
Name:WERBER, FRED ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:ALAN
Last Name:WERBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5955 BRIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1124
Mailing Address - Country:US
Mailing Address - Phone:805-648-1875
Mailing Address - Fax:805-642-1824
Practice Address - Street 1:5955 BRIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1124
Practice Address - Country:US
Practice Address - Phone:805-648-1875
Practice Address - Fax:805-642-1824
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37080207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG37080Medicare ID - Type Unspecified
A46943Medicare UPIN