# LAKE CITY PRIMARY CARE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** RICHARD A WEBBER DBA LAKE CITY PRIMARY CARE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164850053
- **Authorized official:** MS. KELLEY BRAULT (OFFICE MANAGER)
- **Authorized official phone:** (518) 561-8256

## Contact information

- **Practice address:** 16 DEGRANDPRE WAY, SUITE 300, PLATTSBURGH, NY 12901-6451
- **Practice address phone:** (518) 561-8256
- **Mailing address:** 16 DEGRANDPRE WAY, SUITE 300, PLATTSBURGH, NY 12901-6451
- **Mailing address phone:** (518) 561-8256

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 210018 | NY | Yes |
| 207R00000X | Internal Medicine Physician | 210018 | NY | — |

## Other

- **Enumeration date:** 10/31/2013
- **Last updated:** 01/17/2014