Provider Demographics
NPI:1912982109
Name:WEBB, PATRICK MARVIN (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:MARVIN
Last Name:WEBB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 N MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1033
Mailing Address - Country:US
Mailing Address - Phone:574-647-7167
Mailing Address - Fax:574-647-3671
Practice Address - Street 1:615 N MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1033
Practice Address - Country:US
Practice Address - Phone:574-647-7167
Practice Address - Fax:574-647-3671
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056419A207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000315370OtherBCBS LAPORTE
INP01713005OtherRR-MEDICARE
IN200389510Medicaid
IN000000315379OtherBCBS MEDPOINT MAIN STREET
IN000000294237OtherBCBS MEMORIAL HOSPITALIST
IN000000389171OtherBMG E BLAIR WARNER
IN000000878854OtherBCBS IRELAND RD
IN941030004Medicare UPIN
IN565800C5Medicare PIN
IN000000294237OtherBCBS MEMORIAL HOSPITALIST
IN200389510Medicaid
IN236040AAAAMedicare PIN