Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD419417 | PA |
Y | 2080P0204X | Pediatric Emergency Doctor | 09649 | MS |
N | 2080P0204X | Pediatric Emergency Doctor | MD419417 | PA |
NPI | 1003822495 |
---|---|
Provider Name | Emily S Weber |
First Address | Jackson, MS 39216-4500 |
Second Address | Jackson, MS 39216-4500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 26/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00010722 | (05) | MS |
183346 | (05) | AL |
F39865 | (02) |