MEDICARE: PAUL J WEBER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	ME50937	FL

General Provider Information

NPI Number	:	1053405415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL J WEBER MD

Provider Business Mailing Address
First Line	:	5353 NORTH FEDERAL HWY
Second Line	:	STE 400
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308
Country	:	US
Telephone Number	:	954-489-9800
Fax Number	:	954-489-0401

Provider Business Practice Location Address
First Line	:	5353 NORTH FEDERAL HWY
Second Line	:	STE 400
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308
Country	:	US
Telephone Number	:	954-489-9800
Fax Number	:	954-489-0401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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