Healthcare Provider Details

I. General information

NPI: 1487621579
Provider Name (Legal Business Name): S PATRICK WEBER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 03/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PHS HOSPITAL EAST HIGHWAY 18
PINE RIDGE SD
57770
US

IV. Provider business mailing address

PHS HOSPITAL EAST HIGHWAY 18
PINE RIDGE SD
57770
US

V. Phone/Fax

Practice location:
  • Phone: 605-867-5131
  • Fax:
Mailing address:
  • Phone: 605-867-5131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number1413
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: