Healthcare Provider Details

I. General information

NPI: 1992933550
Provider Name (Legal Business Name): DOUGLAS MARK WEBER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1187 E COTTONWOOD LN STE B
CASA GRANDE AZ
85122-2957
US

IV. Provider business mailing address

1187 E COTTONWOOD LN STE B
CASA GRANDE AZ
85122-2957
US

V. Phone/Fax

Practice location:
  • Phone: 520-836-1000
  • Fax: 520-836-6515
Mailing address:
  • Phone: 520-836-1000
  • Fax: 520-836-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number52070
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number125056620
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: