MEDICARE: CLINTON BRADSHAW WEBSTER 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	173000000X	Legal Medicine	362930	UT
2	208200000X	Plastic Surgery Physician	99984	FL
3	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician	99984	FL
4	208200000X	Plastic Surgery Physician	29518	OK
5	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician	29518	OK

General Provider Information

NPI Number	:	1417955063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLINTON BRADSHAW WEBSTER M.D.

Provider Business Mailing Address
First Line	:	3705 NW 63RD ST
Second Line	:	SUITE 204
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1935
Country	:	US
Telephone Number	:	405-842-9732
Fax Number	:	405-842-9771

Provider Business Practice Location Address
First Line	:	3705 NW 63RD ST
Second Line	:	SUITE 204
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1935
Country	:	US
Telephone Number	:	405-842-9732
Fax Number	:	405-842-9771

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	06/13/2013

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