Provider Demographics
NPI:1154360741
Name:WEBB, RODERICK JR
Entity type:Individual
Prefix:
First Name:RODERICK
Middle Name:
Last Name:WEBB
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 WALNUT KNOLL LN
Mailing Address - Street 2:2ND FL
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-8839
Mailing Address - Country:US
Mailing Address - Phone:901-755-7001
Mailing Address - Fax:901-753-2896
Practice Address - Street 1:3525 CHERE CAROL RD
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:TN
Practice Address - Zip Code:38343-3638
Practice Address - Country:US
Practice Address - Phone:731-784-2321
Practice Address - Fax:901-753-2896
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN84362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology