Provider Demographics
NPI:1396837399
Name:WEBB, DAVID LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEWIS
Last Name:WEBB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:LEWIS
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PA
Mailing Address - Street 1:1505 W JEFFERSON ST
Mailing Address - Street 2:STE 160
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-2277
Mailing Address - Country:US
Mailing Address - Phone:972-923-0130
Mailing Address - Fax:972-923-0131
Practice Address - Street 1:1505 W JEFFERSON ST
Practice Address - Street 2:STE 160
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2277
Practice Address - Country:US
Practice Address - Phone:972-923-0130
Practice Address - Fax:972-923-0131
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6203207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114427101Medicaid
TXDA78Medicare ID - Type Unspecified
TX114427101Medicaid