Basic Information
| Provider Information | |||||||||
| NPI: | 1497915102 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOSEPH L. WEBSTER SR. MD. PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2048 CENTRE POINTE LN | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323084300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508780471 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2048 CENTRE POINTE LN | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323084300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508780471 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2008 | ||||||||
| LastUpdateDate: | 02/11/2020 | ||||||||
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| AuthorizedOfficialLastName: | WEBSTER | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8508780471 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | JOSEPH L. WEBSTER SR. MD, PA | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | SR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 039835700 | 05 | FL | MEDICAID |