Provider Demographics
NPI:1467558320
Name:WEBSTER, WILLIAM L (PA-C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:L
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:189 COUNTRY OAKS LN
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27358-8129
Mailing Address - Country:US
Mailing Address - Phone:336-951-0554
Mailing Address - Fax:336-548-4877
Practice Address - Street 1:401 W DECATUR ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NC
Practice Address - Zip Code:27025-1913
Practice Address - Country:US
Practice Address - Phone:336-548-9618
Practice Address - Fax:336-548-4877
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC101650363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2752584AOtherMEDICARE
NC1467558320OtherNC BLUE CROSS