Provider Demographics
NPI:1891756250
Name:WEBER, YVONNE BRIDGETT (DPM)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:BRIDGETT
Last Name:WEBER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 CENTER GREEN DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2364
Mailing Address - Country:US
Mailing Address - Phone:303-443-8900
Mailing Address - Fax:303-442-3140
Practice Address - Street 1:3000 CENTER GREEN DR
Practice Address - Street 2:SUITE 210
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2364
Practice Address - Country:US
Practice Address - Phone:303-443-8900
Practice Address - Fax:303-442-3140
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO478213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCA3923Medicare ID - Type UnspecifiedMEDICARE NUMBER
COU50360Medicare UPIN