Provider Demographics
NPI:1447277066
Name:WEBBER, CHARLES E JR (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:WEBBER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-378-3699
Practice Address - Street 1:800 W MAGNOLIA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4611
Practice Address - Country:US
Practice Address - Phone:817-882-1193
Practice Address - Fax:817-870-1602
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD7498208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00319954OtherRAILROAD MEDICARE
C23267Medicare UPIN
P00319954OtherRAILROAD MEDICARE