Provider Demographics
NPI:1902801814
Name:WEBSTER, GWEN H (MD)
Entity Type:Individual
Prefix:DR
First Name:GWEN
Middle Name:H
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5940 W PARKER RD
Mailing Address - Street 2:STE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-6404
Mailing Address - Country:US
Mailing Address - Phone:972-781-0456
Mailing Address - Fax:972-473-2422
Practice Address - Street 1:5940 W PARKER RD
Practice Address - Street 2:STE 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6404
Practice Address - Country:US
Practice Address - Phone:972-781-0456
Practice Address - Fax:972-473-2422
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5426174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH36771Medicare UPIN