Provider Demographics
NPI:1255327904
Name:RUSSELL P WEBSTER MD PA
Entity Type:Organization
Organization Name:RUSSELL P WEBSTER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:P
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-793-4711
Mailing Address - Street 1:1700 HARRISON ST
Mailing Address - Street 2:STE S
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7316
Mailing Address - Country:US
Mailing Address - Phone:870-793-4711
Mailing Address - Fax:870-793-4864
Practice Address - Street 1:1700 HARRISON ST
Practice Address - Street 2:STE S
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7316
Practice Address - Country:US
Practice Address - Phone:870-793-4711
Practice Address - Fax:870-793-4864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR57431Medicare ID - Type Unspecified
D04992Medicare UPIN