Provider Demographics
NPI:1962489989
Name:WEBER, PAUL H (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:H
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 1:160 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:IA
Mailing Address - Zip Code:50622-9612
Mailing Address - Country:US
Mailing Address - Phone:319-984-5645
Mailing Address - Fax:319-984-5364
Practice Address - Street 1:160 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:IA
Practice Address - Zip Code:50622-9612
Practice Address - Country:US
Practice Address - Phone:319-984-5645
Practice Address - Fax:319-984-5364
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22055207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1962489989Medicaid
IA08016960OtherRR MEDICARE
IA1022897Medicaid
A01628Medicare UPIN
IA1962489989Medicaid