Provider Demographics
NPI:1619981636
Name:WEBER, ROBERT BERNARD (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BERNARD
Last Name:WEBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:BERNARD
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 17763
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-3763
Mailing Address - Country:US
Mailing Address - Phone:310-558-9777
Mailing Address - Fax:310-558-9778
Practice Address - Street 1:12099 W WASHINGTON BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-2621
Practice Address - Country:US
Practice Address - Phone:310-558-9777
Practice Address - Fax:310-558-9778
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30439207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G304391Medicaid
CAG3043913OtherMEDICARE ID
CA00G304391Medicaid
CA1194896332Medicare UPIN
CA1619981636Medicare UPIN
CA1619981636Medicare PIN