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General NPI Number Information
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NPI Number | 1417955063
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Entity Type | Individual
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Provider Name | CLINTON BRADSHAW WEBSTER M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 06/13/2013
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Provider Practice Location Address
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Address Line | 3705 NW 63RD ST SUITE 204
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-1935
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Country | US
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Telephone | 405-842-9732
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Fax | 405-842-9771
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Provider Business Mailing Address
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Address Line | 3705 NW 63RD ST SUITE 204
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-1935
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Country | US
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Telephone | 405-842-9732
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Fax | 405-842-9771
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 362930
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 99984
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2082S0105X
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Taxonomy Name | Surgery of the Hand (Plastic Surgery) Physician
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License Number | 99984
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 29518
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License Number State | OK
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Taxonomy #5
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Taxonomy Code | 2082S0105X
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Taxonomy Name | Surgery of the Hand (Plastic Surgery) Physician
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License Number | 29518
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License Number State | OK
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