Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1108-25 | WI |
Y | 222Z00000X | Podiatrist | 1108-25 | WI |
NPI | 1043655822 |
---|---|
Provider Name | Dr. Jeffrey Scott Weber |
First Address | Wauwatosa, WI 53226-2426 |
Second Address | Traverse City, MI 49686-3397 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2013 |
Last Update Date | 22/04/2021 |