Provider Demographics
NPI:1497915102
Name:JOSEPH L. WEBSTER SR. MD. PA
Entity Type:Organization
Organization Name:JOSEPH L. WEBSTER SR. MD. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:850-878-0471
Mailing Address - Street 1:2048 CENTRE POINTE LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4300
Mailing Address - Country:US
Mailing Address - Phone:850-878-0471
Mailing Address - Fax:
Practice Address - Street 1:2048 CENTRE POINTE LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4300
Practice Address - Country:US
Practice Address - Phone:850-878-0471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH L. WEBSTER SR. MD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-16
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039835700Medicaid