Provider Demographics
NPI:1891884029
Name:WEBSTER, MATTHEW K (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:K
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1105 N ANKENY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4003
Mailing Address - Country:US
Mailing Address - Phone:515-964-4600
Mailing Address - Fax:515-963-4142
Practice Address - Street 1:1105 N ANKENY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4003
Practice Address - Country:US
Practice Address - Phone:515-964-4600
Practice Address - Fax:515-963-4142
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAR7929207Q00000X
IADO-03820207Q00000X, 2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP01437244OtherRR MEDICARE
IA1891884029Medicaid
IA1891884029Medicaid
IAI21331Medicare PIN
IA719260743Medicare PIN