Healthcare Provider Details

I. General information

NPI: 1104989789
Provider Name (Legal Business Name): ANN T WEBER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 NW 83RD ST
GAINESVILLE FL
32606-5603
US

IV. Provider business mailing address

2630 NW 41ST ST C 3
GAINESVILLE FL
32606-7495
US

V. Phone/Fax

Practice location:
  • Phone: 352-375-0166
  • Fax:
Mailing address:
  • Phone: 352-375-0166
  • Fax: 352-376-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME71839
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: