Provider Demographics
NPI:1447361795
Name:WEBSTER, WAYNE (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 SPRUCE ST
Mailing Address - Street 2:STE. 300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2474
Mailing Address - Country:US
Mailing Address - Phone:206-461-6935
Mailing Address - Fax:206-461-8382
Practice Address - Street 1:6020 35TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-3002
Practice Address - Country:US
Practice Address - Phone:206-461-6950
Practice Address - Fax:206-461-8542
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039646207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8275547Medicaid
8853652Medicare ID - Type UnspecifiedGREENWOOD CLINIC
G21050Medicare UPIN
WA8275547Medicaid
8853649Medicare ID - Type Unspecified45TH ST CLINIC
8853651Medicare ID - Type UnspecifiedRAINIERPARK CLINIC
8853650Medicare ID - Type UnspecifiedHIGH POINT CLINIC
8853653Medicare ID - Type UnspecifiedRAINIER BEACH CLINIC