Provider Demographics
NPI:1649507088
Name:WEBB, KLINT LAYTON (PA-C)
Entity type:Individual
Prefix:
First Name:KLINT
Middle Name:LAYTON
Last Name:WEBB
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3130 E BASELINE RD STE 103-104
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-7290
Mailing Address - Country:US
Mailing Address - Phone:480-539-7618
Mailing Address - Fax:480-539-1704
Practice Address - Street 1:3130 E BASELINE RD STE 103-104
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-7290
Practice Address - Country:US
Practice Address - Phone:480-539-7618
Practice Address - Fax:480-539-1704
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4543363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical