Provider Demographics
NPI:1508890666
Name:WEBB, TEDDY E (MD)
Entity Type:Individual
Prefix:
First Name:TEDDY
Middle Name:E
Last Name:WEBB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TED
Other - Middle Name:E
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4401 W MEMORIAL RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1785
Mailing Address - Country:US
Mailing Address - Phone:405-755-4050
Mailing Address - Fax:405-936-5211
Practice Address - Street 1:5201 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-2004
Practice Address - Country:US
Practice Address - Phone:405-755-4050
Practice Address - Fax:405-752-1553
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11834207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK11834OtherLICENSE
OK100192210AMedicaid
OK21023OtherOBNDD
OK080093671OtherRAILROAD
OK21023OtherOBNDD
OK100192210AMedicaid