Provider Demographics
NPI:1275538605
Name:WEBB, AMY E (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:E
Last Name:WEBB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:CANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:911 OAK PARK BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-3405
Mailing Address - Country:US
Mailing Address - Phone:805-474-8700
Mailing Address - Fax:805-474-8466
Practice Address - Street 1:911 OAK PARK BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3405
Practice Address - Country:US
Practice Address - Phone:805-474-8700
Practice Address - Fax:805-474-8466
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64739208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
5622418OtherCCN/FIRST HEALTH PIN
CA00A7647390OtherBLUE SHIELD OF CA PIN
CA00A647390Medicaid
7598095OtherAETNA