Provider Demographics
NPI:1679626097
Name:WEBER, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:WEBER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1129
Mailing Address - Street 2:ELIZABETH BREEDLOVE FAMILY PRACTICE & AESTHETOCS
Mailing Address - City:TATUM
Mailing Address - State:TX
Mailing Address - Zip Code:75691-1129
Mailing Address - Country:US
Mailing Address - Phone:903-947-2020
Mailing Address - Fax:903-947-3292
Practice Address - Street 1:810 N HILL ST
Practice Address - Street 2:SUITE 2
Practice Address - City:TATUM
Practice Address - State:TX
Practice Address - Zip Code:75691-1740
Practice Address - Country:US
Practice Address - Phone:903-947-2020
Practice Address - Fax:903-947-3292
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2014-12-30
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Provider Licenses
StateLicense IDTaxonomies
TXE5641207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC23268Medicare UPIN