Provider Demographics
NPI:1548233976
Name:WEBER, THOMAS O (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:O
Last Name:WEBER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3205 N ACADEMY BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5101
Mailing Address - Country:US
Mailing Address - Phone:719-632-5700
Mailing Address - Fax:719-344-7817
Practice Address - Street 1:3205 N ACADEMY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5101
Practice Address - Country:US
Practice Address - Phone:719-632-5700
Practice Address - Fax:719-344-7837
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2017-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO31721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01317213Medicaid
CO490618Medicare PIN
COH53089Medicare UPIN
COCOA109612Medicare Oscar/Certification