Provider Demographics
NPI:1871760561
Name:COLETTE S. WEBER, D.P.M., LLC
Entity type:Organization
Organization Name:COLETTE S. WEBER, D.P.M., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:314-965-5371
Mailing Address - Street 1:439 S KIRKWOOD RD
Mailing Address - Street 2:STE. 208
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6169
Mailing Address - Country:US
Mailing Address - Phone:314-965-5371
Mailing Address - Fax:314-965-2228
Practice Address - Street 1:439 S KIRKWOOD RD
Practice Address - Street 2:STE. 208
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-6169
Practice Address - Country:US
Practice Address - Phone:314-965-5371
Practice Address - Fax:314-965-2228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000762213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000021434Medicare PIN