Provider Demographics
NPI:1518935311
Name:WEBB, SUSAN ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELAINE
Last Name:WEBB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 PARKWEST BLVD
Mailing Address - Street 2:SUITE 409
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923
Mailing Address - Country:US
Mailing Address - Phone:865-531-1173
Mailing Address - Fax:865-531-8599
Practice Address - Street 1:9330 PARKWEST BLVD
Practice Address - Street 2:SUITE 409
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923
Practice Address - Country:US
Practice Address - Phone:865-531-1173
Practice Address - Fax:865-531-8599
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN029406207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3064312OtherBLUE CROSS BLUE SHIELD
TN3813609Medicare ID - Type Unspecified
TNG55383Medicare UPIN