Provider Demographics
NPI:1417955063
Name:WEBSTER, CLINTON BRADSHAW (MD)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:BRADSHAW
Last Name:WEBSTER
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 1:3705 NW 63RD ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1935
Mailing Address - Country:US
Mailing Address - Phone:405-842-9732
Mailing Address - Fax:405-842-9771
Practice Address - Street 1:3705 NW 63RD ST
Practice Address - Street 2:SUITE 204
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1935
Practice Address - Country:US
Practice Address - Phone:405-842-9732
Practice Address - Fax:405-842-9771
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT362930173000000X
FL99984208200000X, 2082S0105X
OK29518208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No173000000XOther Service ProvidersLegal Medicine
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005563404Medicare PIN
UTI31956Medicare UPIN
FLI31956Medicare UPIN