Organization
GREAT LAKES ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS WEBSTER DO (OWNER)
(972) 715-5000
Entity
Organization
Contact information
Practice address
13601 PRESTON RD, 1000W, DALLAS, TX 75240-4911
(972) 715-5000
Mailing address
13601 PRESTON RD, 1000W, DALLAS, TX 75240-4911
(972) 715-5000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972806925
—
IL
Enumeration date
12/14/2010
Last updated
11/22/2011
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