Healthcare Provider Details

I. General information

NPI: 1437298163
Provider Name (Legal Business Name): JASON MICHAEL WEBB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 NIGHTINGALE RD BLDG 5525 412TH MEDICAL GROUP
EDWARDS AFB CA
93524-6201
US

IV. Provider business mailing address

30 NIGHTINGALE RD BLDG 5525 412TH MEDICAL GROUP
EDWARDS AFB CA
93524-6201
US

V. Phone/Fax

Practice location:
  • Phone: 661-275-2641
  • Fax:
Mailing address:
  • Phone: 661-275-2641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number41860
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: