Healthcare Provider Details

I. General information

NPI: 1902049182
Provider Name (Legal Business Name): JAMI S WEBSTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 COUNTY ROAD 210 W STE 200
ST JOHNS FL
32259-2063
US

IV. Provider business mailing address

2001 COUNTY ROAD 210 W STE 200
ST JOHNS FL
32259-2063
US

V. Phone/Fax

Practice location:
  • Phone: 44-508-1209
  • Fax: 904-230-1066
Mailing address:
  • Phone: 44-508-1209
  • Fax: 904-230-1066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME103394
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: