Healthcare Provider Details

I. General information

NPI: 1447277066
Provider Name (Legal Business Name): CHARLES E WEBBER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W MAGNOLIA AVE SUITE A
FORT WORTH TX
76104-4611
US

IV. Provider business mailing address

PO BOX 961205
FORT WORTH TX
76161-1205
US

V. Phone/Fax

Practice location:
  • Phone: 817-882-1193
  • Fax: 817-870-1602
Mailing address:
  • Phone: 817-740-8400
  • Fax: 817-378-3699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD7498
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: