Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 5101019896 | MI |
NPI | 1386908978 |
---|---|
Provider Name | Dr. Jessica Mae West |
First Address | Flint, MI 48507-3839 |
Second Address | Pontiac, MI 48342-2217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2012 |
Last Update Date | 27/06/2012 |