Individual
JEFFREY KARLTON WEBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
136 A&B LAKE STREET, LAKE STREET FAMILY PRACTICE, EPHRATA, PA 17522
(717) 721-7718
(717) 721-7726
Mailing address
136 A&B LAKE STREET, EPHRATA, PA 17522
(717) 721-7718
(717) 721-7726
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD056265L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015972610005
—
PA
01
—
50051222
CAPITAL BLUE
PA
01
—
5302201
USH/HMO
—
01
—
610531
BLUE SHIELD
PA
01
—
P002413
GATEWAY
—
01
—
P00255545
RAILROAD MEDICARE
—
Enumeration date
09/06/2006
Last updated
09/05/2012
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