Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 2001-331 | NM |
N | 204C00000X | Sports Medicine Doctor | 26994 | CO |
N | 204C00000X | Sports Medicine Doctor | 38254 | MI |
N | 204C00000X | Sports Medicine Doctor | C41531 | CA |
NPI | 1821060633 |
---|---|
Provider Name | Dr. David R Webb |
First Address | Gallup, NM 87301-4918 |
Second Address | Gallup, NM 87301-5682 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000K6295 | (05) | NM |
10002487 | LOVELACE HEALTH/SALUD (01) | NM |
624941 | (05) | AZ |
850313268020 | CHAMPUS (01) | |
F10692 | (02) | |
NM009562 | BCBS (01) | NM |
PROVP16726 | MOLINA (01) | NM |