Healthcare Provider Details

I. General information

NPI: 1518900562
Provider Name (Legal Business Name): BRAD SCOTT WEBB D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 W ROYAL HUNTE DR STE 2
CEDAR CITY UT
84720-8351
US

IV. Provider business mailing address

1811 W ROYAL HUNTE DR STE 2
CEDAR CITY UT
84720-8351
US

V. Phone/Fax

Practice location:
  • Phone: 435-586-2225
  • Fax: 435-867-1909
Mailing address:
  • Phone: 435-586-2225
  • Fax: 435-867-1909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number6044606-0501
License Number StateUT

VII. Legacy identifiers

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

# 1
Identifier528552282001
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer
# 2
IdentifierDF1798
Identifier TypeOTHER
Identifier State
Identifier IssuerPALMETTO GBA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: