Provider Demographics
NPI:1982018164
Name:WEBER, ERICH MCSWAIN (IDC)
Entity Type:Individual
Prefix:
First Name:ERICH
Middle Name:MCSWAIN
Last Name:WEBER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 KEARNY VILLA RD
Mailing Address - Street 2:APT 157
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1971
Mailing Address - Country:US
Mailing Address - Phone:904-612-6643
Mailing Address - Fax:
Practice Address - Street 1:3455 KEARNY VILLA RD
Practice Address - Street 2:APT 157
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1971
Practice Address - Country:US
Practice Address - Phone:904-612-6643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman