Provider Demographics
NPI:1124034681
Name:WEBSTER, DEVON JEAN (MD)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:JEAN
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 NW ELKS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3757
Mailing Address - Country:US
Mailing Address - Phone:541-768-4950
Mailing Address - Fax:541-768-4951
Practice Address - Street 1:501 NW ELKS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3757
Practice Address - Country:US
Practice Address - Phone:541-768-4950
Practice Address - Fax:541-768-4951
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23582207R00000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1032645Medicaid
OR286495Medicaid
OR286495Medicaid
ORR145172Medicare PIN
WAG8895035Medicare PIN