Provider Demographics
NPI:1558439828
Name:WEBER, GAREY LEE (DPM)
Entity Type:Individual
Prefix:DR
First Name:GAREY
Middle Name:LEE
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:PO BOX 7607
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-7607
Mailing Address - Country:US
Mailing Address - Phone:949-289-0685
Mailing Address - Fax:
Practice Address - Street 1:20360 SW BIRCH ST
Practice Address - Street 2:STE 270
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1535
Practice Address - Country:US
Practice Address - Phone:949-833-3406
Practice Address - Fax:949-833-9955
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1371213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGRE001960Medicaid
CAT10920Medicare UPIN
CAGRE001960Medicaid