Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | H5414 | TX |
NPI | 1831196534 |
---|---|
Provider Name | Gunnar West |
First Address | Dallas, TX 75233-1106 |
Second Address | Dallas, TX 75224-3000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 06/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
112788801 | (05) | TX |
E77087 | (02) | TX |