# W. WALLACE WEBSTER MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407470214
- **Authorized official:** DR. WILLIAM WALLACE WEBSTER III MD (OWNER)
- **Authorized official phone:** (541) 297-5342

## Contact information

- **Practice address:** 620 COMMERCIAL AVE STE A, COOS BAY, OR 97420-1846
- **Practice address phone:** (541) 297-5342
- **Practice address fax:** (541) 808-0415
- **Mailing address:** 620 COMMERCIAL AVE STE A, COOS BAY, OR 97420-1846
- **Mailing address phone:** (541) 297-5342
- **Mailing address fax:** (541) 808-0415

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YS0123X | Facial Plastic Surgery Physician | — | NULL | Yes |
| 207YS0123X | Facial Plastic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/08/2020
- **Last updated:** 06/08/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 274244 | — | OR |