Provider Demographics
NPI:1568442671
Name:WEBER, PAUL R (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:WEBER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17360 BROOKHURST ST
Mailing Address - Street 2:ATTN: CREDENTIALING DEPT.
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3828 SCHAUFELE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1791
Practice Address - Country:US
Practice Address - Phone:657-241-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37980207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47311Medicare UPIN
CACB263893Medicare PIN