Healthcare Provider Details

I. General information

NPI: 1598764607
Provider Name (Legal Business Name): DIANA M WEBER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11501 GOLF COURSE RD., NW SUITE 203
ALBUQUERQUE NM
87114
US

IV. Provider business mailing address

PO BOX 26028
ALBUQUERQUE NM
87125-6028
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-7281
  • Fax: 505-262-7622
Mailing address:
  • Phone: 505-262-7963
  • Fax: 505-232-1627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number96-400
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: