Healthcare Provider Details

I. General information

NPI: 1780709055
Provider Name (Legal Business Name): PATRICIA ANN WEBER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15230 15TH AVE NE
SHORELINE WA
98155-7130
US

IV. Provider business mailing address

15230 15TH AVE NE
SHORELINE WA
98155-7130
US

V. Phone/Fax

Practice location:
  • Phone: 206-361-3578
  • Fax: 206-361-5246
Mailing address:
  • Phone: 206-361-3578
  • Fax: 206-361-5246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number22028
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: