Provider Demographics
NPI:1750704912
Name:WEBBER, ALEX EDWARD
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:EDWARD
Last Name:WEBBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6324 W CANTERBURY ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-1008
Mailing Address - Country:US
Mailing Address - Phone:405-747-4969
Mailing Address - Fax:
Practice Address - Street 1:2200 S SANGRE RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-2143
Practice Address - Country:US
Practice Address - Phone:405-747-4969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator