Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 01074731A | IN |
N | 2086S0129X | Vascular Surgeon | 21517 | NE |
N | 2086S0129X | Vascular Surgeon | 33729 | IA |
NPI | 1093795528 |
---|---|
Provider Name | Dr. Thomas Harry Webb III |
First Address | Detroit, MI 48278-1076 |
Second Address | Indianapolis, IN 46237-6340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 09/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03482 | BCBS NE (01) | NE |
0531285 | (05) | IA |
209260108 | (05) | MO |
229939 | MIDLANDS CHOICE (01) | NE |
43494 | IA BCBS (01) | IA |
4707367990006 | UPREHS (01) | NE |
770002435 | RAILROAD (01) | NE |
E47785 | (02) | NE |