Provider Demographics
NPI:1255382677
Name:WEBER, KAREN (DO)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:SAGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0188
Mailing Address - Country:US
Mailing Address - Phone:520-682-4111
Mailing Address - Fax:520-818-3630
Practice Address - Street 1:13395 N MARANA MAIN ST
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-7008
Practice Address - Country:US
Practice Address - Phone:520-682-4111
Practice Address - Fax:520-682-3817
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40375174400000X, 207R00000X
AZ008672207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ385983Medicaid
CO110241330OtherRR MEDICARE
CO94173044Medicaid
CO110241330OtherRR MEDICARE
CO94173044Medicaid