Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | C-3381 | AR |
Y | 208600000X | Surgeon | C-3381 | AR |
N | 2086X0206X | Surgical Oncologist | C-3381 | AR |
NPI | 1306936976 |
---|---|
Provider Name | Kent Westbrook |
First Address | Little Rock, AR 72205-7101 |
Second Address | Little Rock, AR 72205-7101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 12/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12105000000 | QUALCHOICE (01) | AR |
55599 | BLUE CROSS BLUE SHIELD (01) | AR |
B90664 | (02) | |
C3381 | TRICARE (01) | AR |