Provider Demographics
NPI:1467959726
Name:WEBB, BENJAMIN ALLAN (DPM)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ALLAN
Last Name:WEBB
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3171 US HIGHWAY 93 N
Mailing Address - Street 2:STE B
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1360
Mailing Address - Country:US
Mailing Address - Phone:801-400-2269
Mailing Address - Fax:
Practice Address - Street 1:3171 US HIGHWAY 93 N
Practice Address - Street 2:STE B
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1360
Practice Address - Country:US
Practice Address - Phone:219-865-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MTMED-POD-LIC-98419213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program