Healthcare Provider Details

I. General information

NPI: 1316444185
Provider Name (Legal Business Name): PAUL J WEBER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S LIMESTONE ST
SPRINGFIELD OH
45505-1071
US

IV. Provider business mailing address

118 W 1ST ST STE 300
DAYTON OH
45402-1111
US

V. Phone/Fax

Practice location:
  • Phone: 937-323-3781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: