Provider Demographics
NPI:1538322029
Name:WEBER, MICHAEL ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANDREW
Last Name:WEBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DREW
Other - Middle Name:
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-593-8441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-06
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS706-L207P00000X
MS21606207P00000X
TXP1709207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX304969402Medicaid
TX751976930005OtherTRICARE
TXP01070515OtherRAIL ROAD
TX750818167048OtherTRICARE
TX304969403Medicaid
TX750818167022OtherTRICARE
TX304969404Medicaid
TX75-2616977-001OtherTRICARE
TX750818167015OtherTRICARE
TX8DD754OtherBCBS
TXP01304488OtherRAIL ROAD
TX304969401Medicaid
TX75-2616977-028OtherTRICARE
TXP01279299OtherRAIL ROAD
TX75-2616977-002OtherTRICARE
TX750818167044OtherTRICARE
TX8X8167OtherBCBS
TX8DD751OtherBCBS
TX8DU715OtherBCBS
TXTXB158339Medicare Oscar/Certification
TX8DD754OtherBCBS
TXP01304488OtherRAIL ROAD
TX304969401Medicaid