Healthcare Provider Details

I. General information

NPI: 1598811374
Provider Name (Legal Business Name): JOHN ADAMS WEBSTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3109 BIENVILLE BLVD
OCEAN SPRINGS MS
39564-4361
US

IV. Provider business mailing address

2101 HIGHWAY 90
GAUTIER MS
39553-5340
US

V. Phone/Fax

Practice location:
  • Phone: 228-818-1111
  • Fax:
Mailing address:
  • Phone: 228-497-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number25183
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25183
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: