Provider Demographics
NPI:1639827538
Name:WEBER, ISAAC (MD)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:
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 1:2352 FARM ROAD 1063
Mailing Address - Street 2:
Mailing Address - City:MONETT
Mailing Address - State:MO
Mailing Address - Zip Code:65708-6713
Mailing Address - Country:US
Mailing Address - Phone:417-489-9232
Mailing Address - Fax:
Practice Address - Street 1:1665 AURORA CT STE 3004
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2517
Practice Address - Country:US
Practice Address - Phone:303-724-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL.0010571390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty