Healthcare Provider Details

I. General information

NPI: 1164108114
Provider Name (Legal Business Name): JESSE WEBB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIRCLE TRAVIS AFB, CA
APO AA
94535
US

IV. Provider business mailing address

101 BODIN CIRCLE TRAVIS AFB, CA
APO AA
94535
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-3825
  • Fax:
Mailing address:
  • Phone: 707-423-3825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number37473
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: