Provider Demographics
NPI:1104989789
Name:WEBER, ANN T (MD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:T
Last Name:WEBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 NW 41ST ST
Mailing Address - Street 2:C 3
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-7495
Mailing Address - Country:US
Mailing Address - Phone:352-375-0166
Mailing Address - Fax:352-376-1677
Practice Address - Street 1:3750 NW 83RD ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-5603
Practice Address - Country:US
Practice Address - Phone:352-375-0166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71839207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43970OtherBCBS FL
FL264011200Medicaid
FL264011200Medicaid
FL43970OtherBCBS FL