Provider Demographics
NPI:1184872632
Name:WEBB, JOEL THOMAS (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:THOMAS
Last Name:WEBB
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 N 1ST E
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:ID
Mailing Address - Zip Code:83263-1326
Mailing Address - Country:US
Mailing Address - Phone:208-852-3662
Mailing Address - Fax:208-852-1295
Practice Address - Street 1:47 N 1ST E
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:ID
Practice Address - Zip Code:83263
Practice Address - Country:US
Practice Address - Phone:208-852-2900
Practice Address - Fax:208-852-3511
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-766363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1184872632Medicaid
IDPA-766OtherPHYSICIAN ASSISTANT LICENSE