MEDICARE: THERESA SUZANNE WEBER MD

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	2084N0400X	Neurology Physician	J8714	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8AJ320	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720048499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA SUZANNE WEBER MD

Provider Business Mailing Address
First Line	:	205 W WINDCREST ST STE 310
Second Line	:
City	:	FREDERICKSBURG
State	:	TX
Zip	:	78624-4478
Country	:	US
Telephone Number	:	830-997-2191
Fax Number	:	830-997-8202

Provider Business Practice Location Address
First Line	:	205 W WINDCREST ST STE 310
Second Line	:
City	:	FREDERICKSBURG
State	:	TX
Zip	:	78624-4478
Country	:	US
Telephone Number	:	830-997-2191
Fax Number	:	830-997-8202

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

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	10/14/2022

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