Provider Demographics
NPI:1437149085
Name:WEBB, RENICK P (MD)
Entity Type:Individual
Prefix:
First Name:RENICK
Middle Name:P
Last Name:WEBB
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 1:221 WINDERMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3538
Mailing Address - Country:US
Mailing Address - Phone:318-443-9773
Mailing Address - Fax:319-443-9799
Practice Address - Street 1:221 WINDERMERE BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3538
Practice Address - Country:US
Practice Address - Phone:318-443-9773
Practice Address - Fax:319-443-9799
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017368207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
73553OtherBLUE CROSS
LA1355356Medicaid
54645Medicare ID - Type Unspecified
73553OtherBLUE CROSS