Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 015312 | MO |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 15312 | MO |
NPI | 1124107313 |
---|---|
Provider Name | Dr. Richard W Weber JR. |
First Address | Chesterfield, MO 63017 |
Second Address | Chesterfield, MO 63017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 05/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E91510 | (02) |