Provider Demographics
NPI:1942227483
Name:WEBER, BETH C (PA)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:C
Last Name:WEBER
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:714 GRAVOIS RD
Mailing Address - Street 2:STE 210
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7723
Mailing Address - Country:US
Mailing Address - Phone:314-543-5230
Mailing Address - Fax:314-543-5280
Practice Address - Street 1:714 GRAVOIS RD
Practice Address - Street 2:STE 210
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7723
Practice Address - Country:US
Practice Address - Phone:314-543-5230
Practice Address - Fax:314-543-5280
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2017-03-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOPYA 111509363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S86762Medicare UPIN