MEDICARE: MR. WILLIAM EDWARD WEBER JR. 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	208200000X	Plastic Surgery Physician	01027410A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	240004398	OTHER	IN	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000091283	OTHER	IN	ANTHEM BLUE SHIELD

General Provider Information

NPI Number	:	1306880216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM EDWARD WEBER JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 1148
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47402-1148
Country	:	US
Telephone Number	:	812-336-6060
Fax Number	:	812-333-7760

Provider Business Practice Location Address
First Line	:	1455 W 2ND STREET
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47403
Country	:	US
Telephone Number	:	812-336-6060
Fax Number	:	812-333-7760

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	11/20/2007

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Directions to “ MR. WILLIAM EDWARD WEBER JR. MD” Practice Location

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