Provider Demographics
NPI:1497493639
Name:WEBER, DALE (CPS)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:WEBER
Suffix:
Gender:M
Credentials:CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WY
Mailing Address - Zip Code:82515-0271
Mailing Address - Country:US
Mailing Address - Phone:307-851-1167
Mailing Address - Fax:
Practice Address - Street 1:24 GREAT PLAINS ROAD
Practice Address - Street 2:
Practice Address - City:ARAPAHOE
Practice Address - State:WY
Practice Address - Zip Code:82524-8252
Practice Address - Country:US
Practice Address - Phone:307-851-0470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist