Individual
WEBB CLANTON WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1002 BELLEVUE ST SE, SALEM, OR 97301
(503) 814-5554
Mailing address
PO BOX 14001, SALEM, OR 97309-5014
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
20700000X
TN
207P00000X
Emergency Medicine Physician
Primary
DO157451
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2012
TENNESSEE MEDICAL LICENSE
TN
01
—
BP1-0026737
INSTITUTIONAL PERMIT
—
01
—
M8432
TEXAS MEDICAL LICENSE
TX
Enumeration date
05/31/2007
Last updated
05/17/2018
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