Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DE00004144 | WA |
NPI | 1043441686 |
---|---|
Provider Name | Dr. John David West |
First Address | Tacoma, WA 98405-1166 |
Second Address | Tacoma, WA 98405-1166 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2009 |
Last Update Date | 30/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1508933953 | NPI (01) |