Provider Demographics
NPI:1780621995
Name:WEBB, KEITH J (CRNA)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:J
Last Name:WEBB
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:215 ELMWOOD AVENUE
Mailing Address - Street 2:PO BOX 2169
Mailing Address - City:ELMIRA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:14903
Mailing Address - Country:US
Mailing Address - Phone:607-733-3632
Mailing Address - Fax:607-733-1292
Practice Address - Street 1:207 FOOTE AVENUE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14702
Practice Address - Country:US
Practice Address - Phone:716-487-0141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY484630367500000X
PARN346771L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB0607Medicare PIN
NYZ37451Medicare UPIN