Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 N 300 W
WASHINGTON UT
84780-1519
US

IV. Provider business mailing address

156 N 300 W
WASHINGTON UT
84780-1519
US

V. Phone/Fax

Practice location:
  • Phone: 435-668-5676
  • Fax:
Mailing address:
  • Phone: 435-668-5676
  • Fax:

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: