Healthcare Provider Details

I. General information

NPI: 1891754859
Provider Name (Legal Business Name): MR. JOHN WILLIAM WEBER
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 836 BOX 2670
FPO AE
09636
IT

IV. Provider business mailing address

PSC 836 BOX 0473
FPO AE
09636
IT

V. Phone/Fax

Practice location:
  • Phone: 00139095563842
  • Fax:
Mailing address:
  • Phone: 01139095563842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: