Healthcare Provider Details

I. General information

NPI: 1154451318
Provider Name (Legal Business Name): MICHAEL DAVID WEBB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 WILLAMETTE ST STE 2
EUGENE OR
97405-3309
US

IV. Provider business mailing address

3225 WILLAMETTE ST STE 2
EUGENE OR
97405-3309
US

V. Phone/Fax

Practice location:
  • Phone: 541-344-3423
  • Fax:
Mailing address:
  • Phone: 541-344-3423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number15717
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier167874
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerMHN
# 2
Identifier201079
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 3
IdentifierJ3064-03
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerPACIFICSOURCE
# 4
Identifier931130894-03
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerPROVIDENCE INSURANCE
# 5
Identifier8000894
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerHMOO
# 6
IdentifierORW916D
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerODS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: