1073517827 NPI number — DR. CARL G WEBER M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073517827 NPI number — DR. CARL G WEBER M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

WEBER

Provider First Name:

CARL

Provider Middle Name:

G

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1073517827

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/16/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

800 N 5TH AVE

Provider Second Line Business Mailing Address:

STE 101

Provider Business Mailing Address City Name:

SEQUIM

Provider Business Mailing Address State Name:

WA

Provider Business Mailing Address Postal Code:

98382-3045

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

360-582-2690

Provider Business Mailing Address Fax Number:

360-582-2691

Provider First Line Business Practice Location Address:

800 N 5TH AVE

Provider Second Line Business Practice Location Address:

STE 101

Provider Business Practice Location Address City Name:

SEQUIM

Provider Business Practice Location Address State Name:

WA

Provider Business Practice Location Address Postal Code:

98382-3045

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

360-582-2690

Provider Business Practice Location Address Fax Number:

360-582-2691

Provider Enumeration Date:

06/09/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  MD00040818 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 6230157 . This is a "CIGNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 7537336 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 1883652 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 8931741 . This is a "L&I CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 04358891702 . This is a "KITSAP PHYSICIAN SERVICES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 1115724 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
• Identifier: 2146037 . This is a "FIRST HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 5422WE . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 0159039 . This is a "WA LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 04358891798382A03 . This is a "TRICARE WPS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 110242184 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".