Individual
DR. WILLIAM WALLACE WEBSTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1900 WOODLAND DRIVE, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4580
Mailing address
1900 WOODLAND DRIVE, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4580
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
A40097
CA
207P00000X
Emergency Medicine Physician
A40097
CA
207Y00000X
Otolaryngology Physician
Primary
MD27455
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407812365
MEDICARE GROUP NPI NUMBER
OR
05
—
274244
—
OR
01
—
CB3544
TRAV RR MEDICARE GROUP PTAN
OR
01
—
P00628020
TRAV RR MEDICARE PTAN
OR
01
—
R0000WFBTV
MEDICARE GROUP PIN NUMBER
OR
Enumeration date
09/20/2006
Last updated
03/23/2010
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