Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 0101234421 | VA |
NPI | 1205874054 |
---|---|
Provider Name | Timothy D Weber |
First Address | Fredericksburg, VA 22404 |
Second Address | Fredericksburg, VA 22401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 20/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H41288 | (02) | |
P00130719 | RAILROAD MEDICARE (01) |