Provider Demographics
NPI:1962688333
Name:BRUCE J WEBER D O P C
Entity type:Organization
Organization Name:BRUCE J WEBER D O P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-439-7400
Mailing Address - Street 1:9141 GRANT ST STE 140
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4367
Mailing Address - Country:US
Mailing Address - Phone:303-252-0100
Mailing Address - Fax:303-252-0127
Practice Address - Street 1:9141 GRANT ST STE 140
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4367
Practice Address - Country:US
Practice Address - Phone:303-252-0100
Practice Address - Fax:303-252-0127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23073207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD28314Medicare UPIN
CO827113062Medicare PIN
COC800262Medicare PIN