Organization
W. WALLACE WEBSTER MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM WALLACE WEBSTER III MD (OWNER)
(541) 297-5342
Entity
Organization
Contact information
Practice address
620 COMMERCIAL AVE STE A, COOS BAY, OR 97420-1846
(541) 297-5342
(541) 808-0415
Mailing address
620 COMMERCIAL AVE STE A, COOS BAY, OR 97420-1846
(541) 297-5342
(541) 808-0415
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274244
—
OR
Enumeration date
06/08/2020
Last updated
06/08/2020
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