1588616999 NPI number — DR. MARK D WEBSTER MD

Table of content: DR. MARK D WEBSTER MD (NPI 1588616999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588616999 NPI number — DR. MARK D WEBSTER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBSTER
Provider First Name:
MARK
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588616999
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
541 CLINICAL DR
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46202-5233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-481-4362
Provider Business Mailing Address Fax Number:
317-481-4360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1115 RONALD REAGAN PKWY
Provider Second Line Business Practice Location Address:
SUITE 148
Provider Business Practice Location Address City Name:
AVON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46123-6910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-274-7273
Provider Business Practice Location Address Fax Number:
317-278-5494
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  01056957A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01056957B . This is a "CSR" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 01056957A . This is a "LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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