Individual
JORDAN CARL WEBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
513 3RD ST SW, WAGNER, SD 57380-9675
(605) 384-3418
(605) 384-5240
Mailing address
513 3RD ST SW, WAGNER, SD 57380-9675
(605) 384-3418
(605) 384-5240
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0959
SD
Other
Enumeration date
03/01/2012
Last updated
08/21/2019
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