MEDICARE: MR. JOEL CLARK WEBB M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	9601516	NC
2	207VX0201X	Gynecologic Oncology Physician	MD60215295	WA
3	207VX0201X	Gynecologic Oncology Physician	93-421	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD60215295	OTHER	WA	WASHINGTON MD LICENSE
2	6994499	OTHER	UT	STATE OF UTAH DOPL
3	9601516	OTHER	NC	MED LICENSE

General Provider Information

NPI Number	:	1306871462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOEL CLARK WEBB M.D.

Provider Business Mailing Address
First Line	:	4610 JEFFERSON LN NE
Second Line	:	WOMEN'S CANCER AND SURGICAL CARE, PC
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-2117
Country	:	US
Telephone Number	:	505-559-4495
Fax Number	:	505-842-8025

Provider Business Practice Location Address
First Line	:	4610 JEFFERSON LN NE
Second Line	:	WOMEN'S CANCER AND SURGICAL CARE, PC
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-2117
Country	:	US
Telephone Number	:	505-559-4495
Fax Number	:	505-842-8025

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	04/30/2020

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Directions to “ MR. JOEL CLARK WEBB M.D.” Practice Location

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