Provider Demographics
NPI:1659572923
Name:ROBERT J WEBER
Entity Type:Organization
Organization Name:ROBERT J WEBER
Other - Org Name:ROBERT J WEBER MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:ROSEANN
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-722-2422
Mailing Address - Street 1:1066 S GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-4163
Mailing Address - Country:US
Mailing Address - Phone:831-722-2422
Mailing Address - Fax:831-539-2145
Practice Address - Street 1:1066 S GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4163
Practice Address - Country:US
Practice Address - Phone:831-722-2422
Practice Address - Fax:831-539-2145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0710793OtherCLIA
CACN2048OtherPALMETTO GBA RAILROAD MED
CAGR0077550Medicaid
CA05D0710793OtherCLIA
CAX18906Medicare UPIN