Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 5754 | NE |
NPI | 1043319882 |
---|---|
Provider Name | Dr. Thomas J Weber |
First Address | Omaha, NE 68130-2687 |
Second Address | Omaha, NE 68130-2687 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47076927100 | (05) | NE |