Provider Demographics
NPI:1720173248
Name:DOUGLAS A. WEBBER, MD, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DOUGLAS A. WEBBER, MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERRY-WEBBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-666-6000
Mailing Address - Street 1:3171 LOS FELIZ BLVD.
Mailing Address - Street 2:SUITE 309
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1537
Mailing Address - Country:US
Mailing Address - Phone:323-666-6000
Mailing Address - Fax:323-666-3761
Practice Address - Street 1:3171 LOS FELIZ BLVD.
Practice Address - Street 2:SUITE 309
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-1537
Practice Address - Country:US
Practice Address - Phone:323-666-6000
Practice Address - Fax:323-666-3761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83278207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G832780Medicaid
CAG83278OtherCA STATE LICENSE #
CAG83278OtherCA STATE LICENSE #
CAH91805Medicare UPIN
CAW18778Medicare ID - Type UnspecifiedMEDICARE GROUP #