Provider Demographics
NPI:1992896591
Name:WEBER, WAYNE R (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:R
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 1:3050 E AIRPORT WAY
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2404
Mailing Address - Country:US
Mailing Address - Phone:562-426-9661
Mailing Address - Fax:562-426-4227
Practice Address - Street 1:8635 FIRESTONE BLVD
Practice Address - Street 2:SUITE # 100
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5242
Practice Address - Country:US
Practice Address - Phone:562-862-5121
Practice Address - Fax:562-862-3027
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31321207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C313210OtherMEDI-CAL