Provider Demographics
NPI:1700181435
Name:WEBER, EDWARD LAWRENCE (MD)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:LAWRENCE
Last Name:WEBER
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 1:4109 BOULEVARD PLACE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3403
Mailing Address - Country:US
Mailing Address - Phone:262-322-7297
Mailing Address - Fax:
Practice Address - Street 1:4109 BOULEVARD PLACE
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3403
Practice Address - Country:US
Practice Address - Phone:262-322-7297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00009138207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease