Provider Demographics
NPI:1427264019
Name:FOREMAN, WEBSTER WYATT III (LMT)
Entity type:Individual
Prefix:MR
First Name:WEBSTER
Middle Name:WYATT
Last Name:FOREMAN
Suffix:III
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 N TACOMA AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-2928
Mailing Address - Country:US
Mailing Address - Phone:253-474-9670
Mailing Address - Fax:253-474-9692
Practice Address - Street 1:1033 N TACOMA AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-2928
Practice Address - Country:US
Practice Address - Phone:253-474-9670
Practice Address - Fax:253-474-9692
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006282174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist