Provider Demographics
NPI:1992749352
Name:WEBER, JED P (MD)
Entity type:Individual
Prefix:
First Name:JED
Middle Name:P
Last Name:WEBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1988 GULF TO BAY BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3550
Mailing Address - Country:US
Mailing Address - Phone:727-953-8090
Mailing Address - Fax:727-953-8088
Practice Address - Street 1:646 VIRGINIA ST
Practice Address - Street 2:SUITE 701
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698
Practice Address - Country:US
Practice Address - Phone:727-734-9088
Practice Address - Fax:727-210-1198
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2016-10-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME79583174400000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G26873Medicare UPIN
FL49595YMedicare PIN
FLG26873Medicare UPIN
49595Medicare ID - Type Unspecified