Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | J2917 | TX |
N | 208600000X | Surgeon | J2917 | TX |
Y | 2086S0129X | Vascular Surgeon | J2917 | TX |
NPI | 1104892926 |
---|---|
Provider Name | Kent P Webb |
First Address | Dallas, TX 75284-6098 |
Second Address | Tyler, TX 75701-2004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 14/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
115327201 | (05) | TX |
F58127 | (02) |