=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043202476
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEBBER MEDICAL COMPLEX
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2005
-----------------------------------------------------
Last Update Date | 07/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 328 KITTLE RD
-----------------------------------------------------
City | FORREST CITY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72335-2960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-633-0220
-----------------------------------------------------
Fax | 870-633-0212
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 328 KITTLE RD
-----------------------------------------------------
City | FORREST CITY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72335-2960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-633-0220
-----------------------------------------------------
Fax | 870-633-0212
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICAN
-----------------------------------------------------
Name | DR. DAVID LEE WEBBER
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 870-633-0220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | R4242
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------