Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 180 | TX |
N | 222Z00000X | Podiatrist | 180 | TX |
Y | 213E00000X | Podiatrist | 28 | OK |
Y | 222Z00000X | Podiatrist | 28 | OK |
N | 225000000X | Orthotic Fitter | 1148 | TX |
N | 225000000X | Orthotic Fitter | 9 | OK |
NPI | 1639302037 |
---|---|
Provider Name | Blaine N West |
First Address | Sherman, TX 75090-2529 |
Second Address | Sherman, TX 75090-2529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2009 |
Last Update Date | 01/09/2009 |