Provider Demographics
NPI:1285297481
Name:J WEBER MEDICAL GROUP PLLC
Entity type:Organization
Organization Name:J WEBER MEDICAL GROUP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:231-946-8822
Mailing Address - Street 1:620 WOODMERE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3397
Mailing Address - Country:US
Mailing Address - Phone:800-639-0414
Mailing Address - Fax:231-947-0977
Practice Address - Street 1:620 WOODMERE AVE STE C
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3397
Practice Address - Country:US
Practice Address - Phone:800-639-0414
Practice Address - Fax:231-947-0977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-15
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty