Provider Demographics
NPI:1821060633
Name:WEBB, DAVID R (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:WEBB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SUSAN AVE
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-4918
Mailing Address - Country:US
Mailing Address - Phone:505-863-7089
Mailing Address - Fax:
Practice Address - Street 1:1900 REDROCK DR
Practice Address - Street 2:REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE SERVICES
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5682
Practice Address - Country:US
Practice Address - Phone:505-863-7089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2001-331204C00000X
CAC41531204C00000X
CO26994204C00000X
MI38254204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ624941Medicaid
NMNM009562OtherBCBS
850313268020OtherCHAMPUS
NMPROVP16726OtherMOLINA
NM10002487OtherLOVELACE HEALTH/SALUD
NM0000K6295Medicaid
AZ624941Medicaid