Provider Demographics
NPI:1063545127
Name:WEBB, GORDON L (MD)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:L
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 1:3018 JACKSON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-4743
Mailing Address - Country:US
Mailing Address - Phone:318-561-8200
Mailing Address - Fax:318-651-8204
Practice Address - Street 1:3018 JACKSON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-4743
Practice Address - Country:US
Practice Address - Phone:318-561-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB89439Medicare UPIN