Healthcare Provider Details

I. General information

NPI: 1376520338
Provider Name (Legal Business Name): HEATHER A WEBER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 PAINE ST SE SUITE B
BONDURANT IA
50035-1154
US

IV. Provider business mailing address

85 PAINE ST SE SUITE B
BONDURANT IA
50035-1154
US

V. Phone/Fax

Practice location:
  • Phone: 515-957-9740
  • Fax: 515-957-9746
Mailing address:
  • Phone: 515-957-9740
  • Fax: 515-957-9746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3536
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: