Basic Information
| Provider Information | |||||||||
| NPI: | 1609865880 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBB | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | NEPHI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 N CURTIS RD | ||||||||
| Address2: | STE 303 | ||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837061347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088287297 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 N CURTIS RD | ||||||||
| Address2: | STE 303 | ||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837061347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083774000 | ||||||||
| FaxNumber: | 2083758426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2005 | ||||||||
| LastUpdateDate: | 05/18/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207KA0200X | M-7118 | ID | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology | Allergy | 208000000X | M-7118 | ID | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.