Provider Demographics
NPI:1760472021
Name:WEBBER, DAVID LEE I (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:WEBBER
Suffix:I
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 PECAN ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72342-3214
Mailing Address - Country:US
Mailing Address - Phone:870-338-9244
Mailing Address - Fax:870-338-9278
Practice Address - Street 1:504 PECAN ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AR
Practice Address - Zip Code:72342-3214
Practice Address - Country:US
Practice Address - Phone:870-338-9244
Practice Address - Fax:870-338-9278
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR4242207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR120725003Medicaid
AR54969Medicare ID - Type Unspecified
ARF00024Medicare UPIN