Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 10362 | TX |
NPI | 1033222963 |
---|---|
Provider Name | Dr. Jeremy Scott Webster |
First Address | Dallas, TX 75248-1784 |
Second Address | Dallas, TX 75248-1784 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 08/07/2007 |