Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 30968 | TX |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 30968 | TX |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 32000 | NE |
NPI | 1073957361 |
---|---|
Provider Name | Dr. Matthew Jon Weber |
First Address | Kearney, NE 68845-2453 |
Second Address | Kearney, NE 68845-2453 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2013 |
Last Update Date | 07/02/2020 |