MEDICARE: DYLAN RAY WEBB PA

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	363A00000X	Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5620	OTHER	OK	OMB

General Provider Information

NPI Number	:	1528951191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DYLAN RAY WEBB PA

Provider Business Mailing Address
First Line	:	2645 NW 182ND ST
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73012-7606
Country	:	US
Telephone Number	:	405-757-8101
Fax Number	:	405-757-8101

Provider Business Practice Location Address
First Line	:	3300 NW EXPRESSWAY
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4418
Country	:	US
Telephone Number	:	405-949-3011
Fax Number	:

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

Provider Enumeration Date	:	06/02/2025
Last Update Date	:	12/17/2025

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