Provider Demographics
NPI:1508007428
Name:WEBB, RICHARD E
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:E
Last Name:WEBB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 WOODBINE AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-8215
Mailing Address - Country:US
Mailing Address - Phone:540-309-3294
Mailing Address - Fax:865-673-2059
Practice Address - Street 1:2309 WOODBINE AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-8215
Practice Address - Country:US
Practice Address - Phone:540-309-3294
Practice Address - Fax:865-673-2059
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN113091347C00000X
TN194963347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT000280Medicaid