Healthcare Provider Details

I. General information

NPI: 1316995509
Provider Name (Legal Business Name): FREDERICK L WEBER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 05/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10600 MONTGOMERY RD
CINCINNATI OH
45242
US

IV. Provider business mailing address

PO BOX 633448
CINCINNATI OH
45263-3448
US

V. Phone/Fax

Practice location:
  • Phone: 513-794-5600
  • Fax: 513-281-1908
Mailing address:
  • Phone: 513-853-4706
  • Fax: 513-853-4743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35-046677
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number35046677
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: