Basic Information
| Provider Information | |||||||||
| NPI: | 1073517827 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBER | ||||||||
| FirstName: | CARL | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 N 5TH AVE | ||||||||
| Address2: | STE 101 | ||||||||
| City: | SEQUIM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983823045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605822690 | ||||||||
| FaxNumber: | 3605822691 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 N 5TH AVE | ||||||||
| Address2: | STE 101 | ||||||||
| City: | SEQUIM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983823045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605822690 | ||||||||
| FaxNumber: | 3605822691 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 05/16/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD00040818 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 6230157 | 01 | WA | CIGNA | OTHER | 7537336 | 01 | WA | AETNA US HEALTHCARE | OTHER | 1883652 | 01 | WA | UNITED HEALTHCARE | OTHER | 8931741 | 01 | WA | L&I CRIME VICTIMS | OTHER | 04358891702 | 01 | WA | KITSAP PHYSICIAN SERVICES | OTHER | 1115724 | 05 | WA | MEDICAID | 2146037 | 01 | WA | FIRST HEALTH | OTHER | 5422WE | 01 | WA | REGENCE BLUE SHIELD | OTHER | 0159039 | 01 | WA | WA LABOR & INDUSTRIES | OTHER | 04358891798382A03 | 01 | WA | TRICARE WPS | OTHER | 110242184 | 01 | WA | RAIL ROAD MEDICARE | OTHER |