Provider Demographics
NPI:1114913605
Name:WEBB, KRISTOPHER MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:MICHAEL
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 1:3000 N IH 35
Mailing Address - Street 2:SUITE 600
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1804
Mailing Address - Country:US
Mailing Address - Phone:512-474-1114
Mailing Address - Fax:512-474-1118
Practice Address - Street 1:3000 N IH 35
Practice Address - Street 2:SUITE 600
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1804
Practice Address - Country:US
Practice Address - Phone:512-474-1114
Practice Address - Fax:512-474-1118
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40238207T00000X
TXM8421207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I28933Medicare UPIN
KY0030516Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER