MEDICARE: CARMEN THURSTON 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	2084P0800X	Psychiatry Physician	H5499	TX

General Provider Information

NPI Number	:	1356408629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN THURSTON WEBB M.D.

Provider Business Mailing Address
First Line	:	4409 SORREL CT
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-8758
Country	:	US
Telephone Number	:	972-410-1672
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 MCEWEN RD
Second Line	:	#285
City	:	DALLAS
State	:	TX
Zip	:	75244-5113
Country	:	US
Telephone Number	:	972-899-1672
Fax Number	:	214-254-3762

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/08/2007

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