Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD60694527 | WA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD60694527 | WA |
NPI | 1043473598 |
---|---|
Provider Name | Dr. John Reid West SR. |
First Address | Poulsbo, WA 98370-9025 |
Second Address | Poulsbo, WA 98370-9025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2008 |
Last Update Date | 19/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2169137 | (05) | WA |