Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | MD01980 | NJ |
Y | 213ES0131X | Foot Surgery | MD01980 | NJ |
NPI | 1366428823 |
---|---|
Provider Name | Dr. Dana Kenneth Webb |
First Address | Bridgewater, NJ 08807 |
Second Address | Bridgewater, NJ 08807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2005 |
Last Update Date | 15/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3856500 | (05) | NJ |
T51420 | (02) | NJ |