Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD425361 | PA |
N | 111NI0900X | Internist | MD425361 | PA |
Y | 207RC0000X | Internist - Cardiovascular Disease | 35.094997 | OH |
N | 207RC0000X | Internist - Cardiovascular Disease | MD425361 | PA |
N | 208000000X | Pediatrician | MD425361 | PA |
N | 2080P0202X | Pediatric Cardiologist | 35.094997 | OH |
N | 2080P0202X | Pediatric Cardiologist | MD425361 | PA |
NPI | 1225060528 |
---|---|
Provider Name | Gary Webb |
First Address | Cincinnati, OH 45229-3026 |
Second Address | Cincinnati, OH 45229-3026 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 17/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0063011 | (05) | NJ |
1011357330002 | (05) | PA |
I23524 | (02) |