Provider Demographics
NPI:1881754364
Name:DAVID J. WEBER, P.C.
Entity type:Organization
Organization Name:DAVID J. WEBER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-278-6963
Mailing Address - Street 1:407 STONEWALL ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-5115
Mailing Address - Country:US
Mailing Address - Phone:901-278-6963
Mailing Address - Fax:901-274-5224
Practice Address - Street 1:407 STONEWALL ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-5115
Practice Address - Country:US
Practice Address - Phone:901-278-6963
Practice Address - Fax:901-274-5224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21064207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE85864Medicare UPIN
TN3726956Medicare PIN