Healthcare Provider Details

I. General information

NPI: 1578605440
Provider Name (Legal Business Name): STEPHEN A WEEBER DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 FAR HILLS AVE STE 220
KETTERING OH
45429-2353
US

IV. Provider business mailing address

5250 FAR HILLS AVE STE 220
KETTERING OH
45429-2353
US

V. Phone/Fax

Practice location:
  • Phone: 937-438-3338
  • Fax: 937-438-3353
Mailing address:
  • Phone: 937-438-3338
  • Fax: 937-438-3353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateOH

VIII. Authorized Official

Name: DR. STEPHEN ADAMS WEEBER
Title or Position: PODIATRIST OWNER
Credential: DPM
Phone: 937-438-3338