Provider Demographics
NPI:1134427172
Name:WEBBLES, WILLIAM EARL
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EARL
Last Name:WEBBLES
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 1:5220 PALMER LN NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3871
Mailing Address - Country:US
Mailing Address - Phone:507-254-9464
Mailing Address - Fax:
Practice Address - Street 1:5220 PALMER LN NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3871
Practice Address - Country:US
Practice Address - Phone:507-254-9464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
335V00000X
MNMNXO-1218261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier