MEDICARE: MAX L WEST M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	13385	WV
2	207Q00000X	Family Medicine Physician	13385	WV
3	207P00000X	Emergency Medicine Physician	MD430026	PA

General Provider Information

NPI Number	:	1114020419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAX L WEST M.D.

Provider Business Mailing Address
First Line	:	2000 EOFF ST
Second Line	:
City	:	WHEELING
State	:	WV
Zip	:	26003-3823
Country	:	US
Telephone Number	:	304-234-8663
Fax Number	:	304-234-1877

Provider Business Practice Location Address
First Line	:	502 CABELA DR
Second Line	:
City	:	TRIADELPHIA
State	:	WV
Zip	:	26059-1044
Country	:	US
Telephone Number	:	304-217-3506
Fax Number	:	304-217-3510

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	09/26/2013

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