Healthcare Provider Details

I. General information

NPI: 1396471785
Provider Name (Legal Business Name): DR. MATTHEW WEBSTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 ABRAMS RD
DALLAS TX
75214-2607
US

IV. Provider business mailing address

4507 HOLLAND AVE APT 110
DALLAS TX
75219-5748
US

V. Phone/Fax

Practice location:
  • Phone: 214-827-1900
  • Fax:
Mailing address:
  • Phone: 209-487-4349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number81523
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: