Healthcare Provider Details

I. General information

NPI: 1942266838
Provider Name (Legal Business Name): JAMES M WEBB DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 NW COUNCIL DR SUITE 101
GRESHAM OR
97030-3721
US

IV. Provider business mailing address

PO BOX 92900
PORTLAND OR
97292-0900
US

V. Phone/Fax

Practice location:
  • Phone: 503-665-8176
  • Fax: 503-665-8178
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO19434
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier076224
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
Identifier127636
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerWA LABOR & INDUSTRIES

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: