Provider Demographics
NPI:1306033774
Name:WEBSTER, STEVEN WESLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:WESLEY
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1469 S HIGHWAY 40 # C
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-3522
Mailing Address - Country:US
Mailing Address - Phone:435-654-3535
Mailing Address - Fax:435-654-2853
Practice Address - Street 1:1469 S HIGHWAY 40 # C
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-3522
Practice Address - Country:US
Practice Address - Phone:435-654-3535
Practice Address - Fax:435-654-2853
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5744083-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical