Provider Demographics
NPI:1467459479
Name:WEBBER, JAMES THOMAS (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:WEBBER
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:PO BOX 1210
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-1210
Mailing Address - Country:US
Mailing Address - Phone:435-843-3646
Mailing Address - Fax:435-843-2590
Practice Address - Street 1:2055 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-9819
Practice Address - Country:US
Practice Address - Phone:435-843-3646
Practice Address - Fax:435-843-2590
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY524382085R0202X
UT5082893-12052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT300129782Medicare PIN
H16529Medicare UPIN
UT005593901Medicare PIN