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General NPI Number Information
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NPI Number | 1003851619
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Entity Type | Organization
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Legal Business Name | JED P WEBER, M.D.,LLC
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 06/27/2011
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Provider Practice Location Address
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Address Line | 646 VIRGINIA ST SUITE 701
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City | DUNEDIN
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State | FL
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Zip | 34698-6612
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Country | US
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Telephone | 727-734-9088
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Fax | 727-210-1198
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Provider Business Mailing Address
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Address Line | 646 VIRGINIA ST SUITE 701
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City | DUNEDIN
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State | FL
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Zip | 34698-6612
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Country | US
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Telephone | 727-734-9088
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Fax | 727-210-1198
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Authorized Official
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Title or Position | OWNER
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Name | JED PAUL WEBER
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Credential | M.D.
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Telephone | 727-734-9088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9102790
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA2726
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA2726
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9102790
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License Number State | FL
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