Provider Demographics
NPI:1740215276
Name:WEBB, GAVIN R (MD)
Entity Type:Individual
Prefix:
First Name:GAVIN
Middle Name:R
Last Name:WEBB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 MARSH BROOK DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-6523
Mailing Address - Country:US
Mailing Address - Phone:603-742-2007
Mailing Address - Fax:603-749-4605
Practice Address - Street 1:7 MARSH BROOK DR STE 205
Practice Address - Street 2:
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-6523
Practice Address - Country:US
Practice Address - Phone:603-742-2007
Practice Address - Fax:603-749-4605
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH12684207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3079441Medicaid
NH30205275Medicaid