MEDICARE: DR. AMY E. WEBB M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A64739	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5622418	OTHER		CCN/FIRST HEALTH PIN
2	00A7647390	OTHER	CA	BLUE SHIELD OF CA PIN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	7598095	OTHER		AETNA

General Provider Information

NPI Number	:	1275538605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY E. WEBB M.D.

Provider Business Mailing Address
First Line	:	911 OAK PARK BLVD
Second Line	:	SUITE 107
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-3405
Country	:	US
Telephone Number	:	805-474-8700
Fax Number	:	805-474-8466

Provider Business Practice Location Address
First Line	:	911 OAK PARK BLVD
Second Line	:	SUITE 107
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-3405
Country	:	US
Telephone Number	:	805-474-8700
Fax Number	:	805-474-8466

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	06/19/2012

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