Provider Demographics
NPI:1588879845
Name:WEBB, DAVID LOUIS JR (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LOUIS
Last Name:WEBB
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1407 UNION AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3641
Mailing Address - Country:US
Mailing Address - Phone:901-866-8372
Mailing Address - Fax:901-302-2372
Practice Address - Street 1:6029 WALNUT GROVE RD STE 106
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2112
Practice Address - Country:US
Practice Address - Phone:901-866-8530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47392208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1588879845Medicaid
GA003181874AMedicaid
TN1524604Medicaid
AR187951001Medicaid
MS1588879845Medicaid
AL189878Medicaid