Provider Demographics
NPI:1457514036
Name:KURT A WEVER MD PC
Entity Type:Organization
Organization Name:KURT A WEVER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-689-6300
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:CRIPPLE CREEK
Mailing Address - State:CO
Mailing Address - Zip Code:80813-0245
Mailing Address - Country:US
Mailing Address - Phone:719-689-6300
Mailing Address - Fax:719-689-6303
Practice Address - Street 1:1101 TELLER COUNTY RD 1
Practice Address - Street 2:
Practice Address - City:CRIPPLE CREEK
Practice Address - State:CO
Practice Address - Zip Code:80813
Practice Address - Country:US
Practice Address - Phone:719-689-6300
Practice Address - Fax:719-689-6303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty