Provider Demographics
NPI:1003858010
Name:WEBB, JOHN QA JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:QA
Last Name:WEBB
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 EASTEX FWY
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77708-5320
Mailing Address - Country:US
Mailing Address - Phone:409-924-8600
Mailing Address - Fax:409-924-8611
Practice Address - Street 1:5220 EASTEX FWY
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77708-5320
Practice Address - Country:US
Practice Address - Phone:409-924-8600
Practice Address - Fax:409-924-8611
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3137208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AM940OtherBLUE CROSS BLUE SHIELD
TX8F6506Medicare PIN
TX8AM940OtherBLUE CROSS BLUE SHIELD