Provider Demographics
NPI:1255396867
Name:WEBB, MARK GERARD (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:GERARD
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 1:10900 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5216
Mailing Address - Country:US
Mailing Address - Phone:480-991-5088
Mailing Address - Fax:480-367-1361
Practice Address - Street 1:10900 N SCOTTSDALE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5216
Practice Address - Country:US
Practice Address - Phone:480-991-5088
Practice Address - Fax:480-367-1361
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19868207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG24106Medicare UPIN