Provider Demographics
NPI:1093711889
Name:WEBB, STEPHEN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:EDWARD
Last Name:WEBB
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 1:2811 LEMMON AVE E
Mailing Address - Street 2:STE 302
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2845
Mailing Address - Country:US
Mailing Address - Phone:214-528-6551
Mailing Address - Fax:214-528-1903
Practice Address - Street 1:2811 LEMMON AVE E
Practice Address - Street 2:STE 302
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2845
Practice Address - Country:US
Practice Address - Phone:214-528-6551
Practice Address - Fax:214-528-1903
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-26
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2926207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE2926OtherSTATE BOARD LICENSE
TX10024452OtherDPS
TX114009702Medicaid
TXC23259Medicare UPIN
TX10024452OtherDPS