MEDICARE: MRS. PAM HARRIS WEBER M.ED.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		TX

General Provider Information

NPI Number	:	1659578730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAM HARRIS WEBER M.ED.

Provider Business Mailing Address
First Line	:	600 S DENTON TAP RD
Second Line	:	SUITE NUMBER 122
City	:	COPPELL
State	:	TX
Zip	:	75019-4533
Country	:	US
Telephone Number	:	214-674-0881
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 S DENTON TAP RD
Second Line	:	SUITE NUMBER 122
City	:	COPPELL
State	:	TX
Zip	:	75019-4533
Country	:	US
Telephone Number	:	214-674-0881
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	07/25/2007

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