Provider Demographics
NPI:1528030079
Name:WEBER, JOHN CONRAD (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CONRAD
Last Name:WEBER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 W CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:OELWEIN
Mailing Address - State:IA
Mailing Address - Zip Code:50662-1642
Mailing Address - Country:US
Mailing Address - Phone:319-283-1373
Mailing Address - Fax:319-283-9184
Practice Address - Street 1:28 W CHARLES ST
Practice Address - Street 2:
Practice Address - City:OELWEIN
Practice Address - State:IA
Practice Address - Zip Code:50662-1642
Practice Address - Country:US
Practice Address - Phone:319-283-1373
Practice Address - Fax:319-283-9184
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2007-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA303213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA02878Medicare ID - Type Unspecified
IAT00352Medicare UPIN