Individual
IRA TED WEBB JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
105 WESTWOOD CMN, BLUEFIELD, VA 24605-2031
(276) 235-6232
(276) 250-5117
Mailing address
200 12TH STREET EXT, PRINCETON, WV 24740-2329
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110840810
VA
363A00000X
Physician Assistant
762
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001920236
BLUE SHIELD
WV
01
—
P00023341
RRGA
WV
Enumeration date
06/13/2006
Last updated
04/05/2024
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