Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 3715-13 | MS |
N | 1223S0112X | Oral and Maxillofacial Surgeon | OS-527-17 | MS |
NPI | 1053752642 |
---|---|
Provider Name | Dr. Griffin Harold West |
First Address | Hattiesburg, MS 39402-3108 |
Second Address | Hattiesburg, MS 39402-3108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2013 |
Last Update Date | 21/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8956501 | (05) | MS |