Provider Information for 1083223010
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Mr. GERALD DWAYNE WEBB LPC
Sex: Male
NPI: 1083223010
Last Updated: 2024-10-10
Certification Date: 2024-10-10
Certification Date: 2024-10-10
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1083223010 | ||||||||
| Enumeration Date | 2020-07-27 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1305 E MAIN ST RUSSELLVILLE, AR 72801-5322 United States Phone: 501-889-4880 | Fax:479-777-9928 | ||||||||
| Primary Practice Address | 1305 E MAIN ST RUSSELLVILLE, AR 72801-5322 United States Phone: 501-889-4880 | Fax:479-777-9928 | ||||||||
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