Provider Demographics
NPI:1790740603
Name:WEBB, WILLIAM WATSON (MD, PH D)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WATSON
Last Name:WEBB
Suffix:
Gender:M
Credentials:MD, PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:BOX 42
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-349-2266
Mailing Address - Fax:269-349-0792
Practice Address - Street 1:3304 COOLEY COURT
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024
Practice Address - Country:US
Practice Address - Phone:269-349-2266
Practice Address - Fax:269-349-0792
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWW054328207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1790740603OtherNPI
MI4307839OtherKALAMAZOO COUNTY HEALTH PLAN
MI0M92920007OtherMEDICARE
MI123693OtherGREAT LAKES HEALTH PLAN
MI1790740603Medicaid
MI100C914640OtherBCBS 04/25/2008 AND AFTER
MI104307839Medicaid
MI383309299059OtherCARESOURCE MEDICAID
MI100C910690OtherBLUE CROSS BLUE SHIELD
MI1417961137OtherBCBSM - BRONSON
MI0P56360003OtherMEDICARE 04/25/2008
MI1851569958OtherGROUP NPI 04/25/2008 AND AFTER
MI1417961137OtherBCBSM - BRONSON
MI4307839OtherKALAMAZOO COUNTY HEALTH PLAN
MI1851569958OtherGROUP NPI 04/25/2008 AND AFTER
MI104307839Medicaid