Provider Demographics
NPI:1134119571
Name:WEBB, CRAIG R (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:R
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 1:3006 S SENECA ST
Mailing Address - Street 2:MEDEXPRESS
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-3210
Mailing Address - Country:US
Mailing Address - Phone:316-522-4635
Mailing Address - Fax:
Practice Address - Street 1:3006 S SENECA ST
Practice Address - Street 2:MEDEXPRESS
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67217-3210
Practice Address - Country:US
Practice Address - Phone:316-522-4635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051853208000000X
CODR.0055577208000000X
KS04-38735208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73150258Medicaid
CO026702OtherKAISER COMMERCIAL NUMBER
CO448221YK5YMedicare PIN
CO73150258Medicaid