Healthcare Provider Details

I. General information

NPI: 1215291992
Provider Name (Legal Business Name): MATT TRANE WEBB DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W TABERNACLE ST STE 2
ST GEORGE UT
84770-3797
US

IV. Provider business mailing address

415 W TABERNACLE ST STE 2
ST GEORGE UT
84770-3797
US

V. Phone/Fax

Practice location:
  • Phone: 435-656-1777
  • Fax: 435-673-2714
Mailing address:
  • Phone: 435-656-1777
  • Fax: 435-673-2714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number325186-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: