Healthcare Provider Details

I. General information

NPI: 1154432094
Provider Name (Legal Business Name): THOMAS ANDREW WEBSTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: THOMAS ANDREW WEBSTER MD

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
TACOMA WA
98431-1089
US

IV. Provider business mailing address

5900 WALNUT SPRINGS BLVD
SYLVANIA OH
43560-8617
US

V. Phone/Fax

Practice location:
  • Phone: 850-452-8051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number295776
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0431962
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberMD60851665
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: