Healthcare Provider Details

I. General information

NPI: 1235516337
Provider Name (Legal Business Name): AARON AUGUST WEBER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 GALLAGHER AVE
ROSCOMMON MI
48653-8344
US

IV. Provider business mailing address

300 GALLAGHER AVE
ROSCOMMON MI
48653-8344
US

V. Phone/Fax

Practice location:
  • Phone: 646-522-8695
  • Fax:
Mailing address:
  • Phone: 646-522-8695
  • Fax: 989-348-2723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601008771
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number018446-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: