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General NPI Number Information
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NPI Number | 1952581944
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Entity Type | Individual
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Provider Name | MARK D WEBSTER PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 04/09/2013
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Provider Practice Location Address
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Address Line | 215 S ALLISON AVE
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City | XENIA
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State | OH
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Zip | 45385-3694
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Country | US
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Telephone | 937-376-2571
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Fax | 937-376-2930
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Provider Business Mailing Address
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Address Line | 2424 HILL AVE
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City | MIDDLETOWN
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State | OH
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Zip | 45044-4732
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Country | US
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Telephone | 937-231-1250
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1025
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License Number State | OH
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