Provider Demographics
NPI:1851724561
Name:WEBB, JOHNLUKAS BUTLER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNLUKAS
Middle Name:BUTLER
Last Name:WEBB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LUKE
Other - Middle Name:BUTLER
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1700 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3398
Mailing Address - Country:US
Mailing Address - Phone:541-296-1111
Mailing Address - Fax:440-627-2170
Practice Address - Street 1:1700 E 19TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3317
Practice Address - Country:US
Practice Address - Phone:541-296-1111
Practice Address - Fax:440-627-2170
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS4249207P00000X
ORMD196190207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine