Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME50937 | FL |
NPI | 1053405415 |
---|---|
Provider Name | Paul J Weber |
First Address | Fort Lauderdale, FL 33308 |
Second Address | Fort Lauderdale, FL 33308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D61263 | (02) |