Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 8039 | WA |
NPI | 1033214861 |
---|---|
Provider Name | Charles R Weber |
First Address | Olympia, WA 98506 |
Second Address | Olympia, WA 98506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 08/07/2007 |