Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 35034 | CO |
NPI | 1023076122 |
---|---|
Provider Name | Leroy Arthur Weber |
First Address | Grand Junction, CO 81501-8801 |
Second Address | Grand Junction, CO 81501-8801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 28/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01350347 | (05) | CO |
E29810 | (02) |