Provider Demographics
NPI:1912347634
Name:WEBB, GEOFF D (BACHELORS OF ARTS)
Entity Type:Individual
Prefix:
First Name:GEOFF
Middle Name:D
Last Name:WEBB
Suffix:
Gender:M
Credentials:BACHELORS OF ARTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33493 S BURNT CABIN RD
Mailing Address - Street 2:
Mailing Address - City:PARK HILL
Mailing Address - State:OK
Mailing Address - Zip Code:74451-2077
Mailing Address - Country:US
Mailing Address - Phone:918-698-0994
Mailing Address - Fax:
Practice Address - Street 1:15481 N JARVIS RD
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-0233
Practice Address - Country:US
Practice Address - Phone:918-456-5131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor