Provider Demographics
NPI:1518035716
Name:WEBBER, WALTER RALPH (DO)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:RALPH
Last Name:WEBBER
Suffix:
Gender:M
Credentials:DO
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 265
Mailing Address - Street 2:3491 N 31
Mailing Address - City:CONWAY
Mailing Address - State:MI
Mailing Address - Zip Code:49722
Mailing Address - Country:US
Mailing Address - Phone:231-348-7016
Mailing Address - Fax:
Practice Address - Street 1:3491 US 31 N
Practice Address - Street 2:941 E PORTAGE
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783
Practice Address - Country:US
Practice Address - Phone:906-253-9556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI005561207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F27432Medicare UPIN
0M06160Medicare ID - Type Unspecified