Provider Demographics
NPI:1316176472
Name:AMMON D. WEBER MD PLLC
Entity type:Organization
Organization Name:AMMON D. WEBER MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMMON
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-274-5131
Mailing Address - Street 1:100 S MCGEE ST
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-4041
Mailing Address - Country:US
Mailing Address - Phone:806-274-5131
Mailing Address - Fax:806-274-5132
Practice Address - Street 1:100 S MCGEE ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4041
Practice Address - Country:US
Practice Address - Phone:806-274-5131
Practice Address - Fax:806-274-5132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health