Provider Demographics
NPI:1184309189
Name:WEBB, JAKE MATTHEW (PA-S)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:MATTHEW
Last Name:WEBB
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 STADIUM WAY UNIT 4202
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2160
Mailing Address - Country:US
Mailing Address - Phone:765-414-4456
Mailing Address - Fax:
Practice Address - Street 1:1415 STADIUM WAY UNIT 4202
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2160
Practice Address - Country:US
Practice Address - Phone:765-414-4456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program