MEDICARE: RANDALL WEBB MD

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	2084N0400X	Neurology Physician	16276	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275560708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDALL WEBB MD

Provider Business Mailing Address
First Line	:	1145 S UTICA AVE STE 110
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74104-4013
Country	:	US
Telephone Number	:	918-579-3825
Fax Number	:

Provider Business Practice Location Address
First Line	:	9001 S 101ST EAST AVE STE 190
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-5799
Country	:	US
Telephone Number	:	918-579-3870
Fax Number	:

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	01/12/2022

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Directions to “ RANDALL WEBB MD” Practice Location

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