Provider Demographics
NPI:1972516086
Name:WEBER, DENISE SAMANTHA (MD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:SAMANTHA
Last Name:WEBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 SWISS AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6251
Mailing Address - Country:US
Mailing Address - Phone:214-828-5070
Mailing Address - Fax:214-828-5071
Practice Address - Street 1:3434 SWISS AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6251
Practice Address - Country:US
Practice Address - Phone:214-828-5070
Practice Address - Fax:214-828-5071
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2008-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3656207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84425XOtherBCBS
TX044863101Medicaid
TX84425XOtherBCBS
TX110189695Medicare PIN
TXG85828Medicare UPIN