Basic Information
| Provider Information | |||||||||
| NPI: | 1912347634 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBB | ||||||||
| FirstName: | GEOFF | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | BACHELORS OF ARTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33493 S BURNT CABIN RD | ||||||||
| Address2: | |||||||||
| City: | PARK HILL | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744512077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186980994 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15481 N JARVIS RD | ||||||||
| Address2: | |||||||||
| City: | TAHLEQUAH | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744640233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184565131 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2013 | ||||||||
| LastUpdateDate: | 06/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171W00000X | Y | Other Service Providers | Contractor |
No ID Information.