Provider Demographics
NPI:1659578730
Name:WEBER, PAM HARRIS (MED)
Entity Type:Individual
Prefix:MRS
First Name:PAM
Middle Name:HARRIS
Last Name:WEBER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S DENTON TAP RD
Mailing Address - Street 2:SUITE NUMBER 122
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4533
Mailing Address - Country:US
Mailing Address - Phone:214-674-0881
Mailing Address - Fax:
Practice Address - Street 1:600 S DENTON TAP RD
Practice Address - Street 2:SUITE NUMBER 122
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4533
Practice Address - Country:US
Practice Address - Phone:214-674-0881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist