Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 000762 | MO |
NPI | 1306848007 |
---|---|
Provider Name | Colette S. Weber |
First Address | Saint Louis, MO 63122-6169 |
Second Address | Saint Louis, MO 63122-6169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 28/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U66372 | (02) |