Provider Demographics
NPI:1942494026
Name:JOHN Q. A. WEBB JR MD PA
Entity Type:Organization
Organization Name:JOHN Q. A. WEBB JR MD PA
Other - Org Name:BEAUMONT MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:QUINCY ADAM
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:409-924-8600
Mailing Address - Street 1:5220 EASTEX FWY
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77708-5320
Mailing Address - Country:US
Mailing Address - Phone:409-924-8600
Mailing Address - Fax:409-924-8611
Practice Address - Street 1:5220 EASTEX FWY
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77708-5320
Practice Address - Country:US
Practice Address - Phone:409-924-8600
Practice Address - Fax:409-924-8611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3137174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0091QCOtherBLUE CROSS BLUE SHIELD
TXD69235Medicare UPIN
TX00Y348Medicare PIN