Provider Demographics
NPI:1598262644
Name:WEEBER, KAITLYN (MD)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:WEEBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 MEDICAL GROUP, UNIT 2060
Mailing Address - Street 2:ATTN: EMERGENCY SERVICES, CAPT WEEBER
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96278-2060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:51 MEDICAL GROUP, UNIT 2060
Practice Address - Street 2:ATTN: EMERGENCY SERVICES, CAPT WEEBER
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96278-0000
Practice Address - Country:US
Practice Address - Phone:707-423-3826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101268753171000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171000000XOther Service ProvidersMilitary Health Care Provider