Healthcare Provider Details

I. General information

NPI: 1689396582
Provider Name (Legal Business Name): MATTHEW THOMAS WEBB IDMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 N ROFF AVE
OKLAHOMA CITY OK
73107-3736
US

IV. Provider business mailing address

1738 N ROFF AVE
OKLAHOMA CITY OK
73107-3736
US

V. Phone/Fax

Practice location:
  • Phone: 405-206-8426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: