Provider Demographics
NPI:1851499248
Name:WEBER, AMMON DAVID (MD)
Entity Type:Individual
Prefix:MR
First Name:AMMON
Middle Name:DAVID
Last Name:WEBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S MCGEE ST
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-4020
Mailing Address - Country:US
Mailing Address - Phone:806-274-5131
Mailing Address - Fax:806-274-5132
Practice Address - Street 1:100 S MCGEE ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4020
Practice Address - Country:US
Practice Address - Phone:806-274-5131
Practice Address - Fax:806-274-5132
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4646207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188178101Medicaid
H75979Medicare UPIN
TX00X692Medicare PIN
TX188178101Medicaid