Healthcare Provider Details

I. General information

NPI: 1831726363
Provider Name (Legal Business Name): JACKIE CHRISTOPHER WEBB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 RED RIVER ST
AUSTIN TX
78712-1845
US

IV. Provider business mailing address

1501 RED RIVER ST
AUSTIN TX
78712-1845
US

V. Phone/Fax

Practice location:
  • Phone: 512-495-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberV3455
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: