Provider Demographics
NPI:1326029620
Name:WEBB, TERRELL R (MD)
Entity type:Individual
Prefix:DR
First Name:TERRELL
Middle Name:R
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 1:781 PARKDALE PL
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-2411
Mailing Address - Country:US
Mailing Address - Phone:303-635-6811
Mailing Address - Fax:303-635-6811
Practice Address - Street 1:781 PARKDALE PL
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-2411
Practice Address - Country:US
Practice Address - Phone:303-635-6811
Practice Address - Fax:303-635-6811
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2011-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24408207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00400886OtherRAILROAD MEDICARE
CO01244086Medicaid
COCOA102660Medicare PIN
COCOA100951Medicare PIN
COP00400886OtherRAILROAD MEDICARE
FLD24443Medicare UPIN
COCOA102655Medicare PIN
CO01244086Medicaid
COCOA100596Medicare PIN