Provider Demographics
NPI:1659847895
Name:WEBB, MATTHEW WILSON (MPAS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:WILSON
Last Name:WEBB
Suffix:
Gender:M
Credentials:MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1262 JESTER CT
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-8102
Mailing Address - Country:US
Mailing Address - Phone:260-450-7180
Mailing Address - Fax:
Practice Address - Street 1:31ST AND BATTALION AVENUE
Practice Address - Street 2:BENNETT HEALTH CLINIC
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-618-8098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant