Provider Demographics
NPI:1447534813
Name:WEBSTER, RICK
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N9916 MOSCH RD
Mailing Address - Street 2:
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-9164
Mailing Address - Country:US
Mailing Address - Phone:715-453-2873
Mailing Address - Fax:
Practice Address - Street 1:N9916 MOSCH RD
Practice Address - Street 2:
Practice Address - City:TOMAHAWK
Practice Address - State:WI
Practice Address - Zip Code:54487-9164
Practice Address - Country:US
Practice Address - Phone:715-453-2873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver