MEDICARE: DR. TERRELL R 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	207Q00000X	Family Medicine Physician	24408	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00400886	OTHER	CO	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1326029620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRELL R WEBB M.D.

Provider Business Mailing Address
First Line	:	781 PARKDALE PL
Second Line	:
City	:	ERIE
State	:	CO
Zip	:	80516-2411
Country	:	US
Telephone Number	:	303-635-6811
Fax Number	:	303-635-6811

Provider Business Practice Location Address
First Line	:	781 PARKDALE PL
Second Line	:
City	:	ERIE
State	:	CO
Zip	:	80516-2411
Country	:	US
Telephone Number	:	303-635-6811
Fax Number	:	303-635-6811

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	11/05/2011

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