Provider Demographics
NPI:1972740678
Name:DAVID LEE WEBBER, D.O. P.A.
Entity type:Organization
Organization Name:DAVID LEE WEBBER, D.O. P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CCS
Authorized Official - Phone:870-633-0220
Mailing Address - Street 1:207 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:AR
Mailing Address - Zip Code:72360-2071
Mailing Address - Country:US
Mailing Address - Phone:870-295-2367
Mailing Address - Fax:870-295-4795
Practice Address - Street 1:328 KITTLE RD
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2960
Practice Address - Country:US
Practice Address - Phone:870-633-0220
Practice Address - Fax:870-295-4795
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID LEE WEBBER, D.O. P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-16
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR4242208D00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR179887729Medicaid
AR5C444Medicare UPIN
AR179887729Medicaid