Provider Demographics
NPI:1063470540
Name:WEBSTER, PAUL STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:STEPHEN
Last Name:WEBSTER
Suffix:
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:PO BOX 420037
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34742-0037
Mailing Address - Country:US
Mailing Address - Phone:321-442-8009
Mailing Address - Fax:321-442-8012
Practice Address - Street 1:825 E OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5838
Practice Address - Country:US
Practice Address - Phone:321-442-8009
Practice Address - Fax:321-442-8012
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067861207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378538601Medicaid
FL27846Medicare ID - Type Unspecified
FL378538601Medicaid