Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 0438000042 | VA |
NPI | 1013982552 |
---|---|
Provider Name | Dr. Lionel Warren West |
First Address | Williamsburg, VA 23188-3406 |
Second Address | Williamsburg, VA 23188-3406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8001260 | (05) | VA |
T78297 | (02) | VA |