Provider Demographics
NPI: | 1700290574 |
---|---|
Name: | WEBB, CLAIRESE (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | CLAIRESE |
Middle Name: | |
Last Name: | WEBB |
Suffix: | |
Gender: | F |
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: | PO BOX 9007 |
Mailing Address - Street 2: | |
Mailing Address - City: | SPRINGFIELD |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 65808-9007 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 417-269-7246 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1001 E PRIMROSE ST |
Practice Address - Street 2: | |
Practice Address - City: | SPRINGFIELD |
Practice Address - State: | MO |
Practice Address - Zip Code: | 65807 |
Practice Address - Country: | US |
Practice Address - Phone: | 417-269-7246 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2014-06-19 |
Last Update Date: | 2022-06-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OK | 30622 | 207L00000X |
MO | 2019005956 | 208VP0014X, 207LP2900X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | |
No | 208VP0014X | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MO | 200070253 | Medicaid |