Provider Demographics
NPI:1124129671
Name:WEBSTER, BRIAN RICHARD (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:RICHARD
Last Name:WEBSTER
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 1:1202 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7307
Mailing Address - Country:US
Mailing Address - Phone:910-341-3336
Mailing Address - Fax:910-251-2066
Practice Address - Street 1:1124 GALLERY PARK BOULEVARD
Practice Address - Street 2:#200
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412
Practice Address - Country:US
Practice Address - Phone:910-341-3336
Practice Address - Fax:910-251-2066
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102893207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC110125052OtherRAILROAD MEDICARE
NC86277OtherBCBS NC
NC8986277Medicaid
NC2224604BMedicare PIN
NC86277OtherBCBS NC
NC2224604AMedicare PIN