Provider Demographics
NPI:1588084982
Name:WEBSTER, YTHAN
Entity type:Individual
Prefix:
First Name:YTHAN
Middle Name:
Last Name:WEBSTER
Suffix:
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:PO BOX 12248
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28561-2248
Mailing Address - Country:US
Mailing Address - Phone:252-637-3988
Mailing Address - Fax:
Practice Address - Street 1:1421 S GLENBURNIE RD STE D
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2603
Practice Address - Country:US
Practice Address - Phone:252-637-3988
Practice Address - Fax:252-637-0553
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC676213EP1101X, 213E00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program