Provider Demographics
NPI:1285613646
Name:WEBER, PHILIP FREDERICK (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:FREDERICK
Last Name:WEBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 LAKEBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1004
Mailing Address - Country:US
Mailing Address - Phone:303-444-3703
Mailing Address - Fax:
Practice Address - Street 1:1155 ALPINE AVE
Practice Address - Street 2:SUITE 360
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3495
Practice Address - Country:US
Practice Address - Phone:303-938-3280
Practice Address - Fax:303-440-9629
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0018572207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01185727Medicaid
COD23462Medicare UPIN
CO01185727Medicaid