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NPI Code Detail

MEDICARE: DEREK LYNN WEST DO

MEDICARE: DEREK LYNN WEST DO
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
1207XX0005XSports Medicine (Orthopaedic Surgery) Physician4001OK
2207XX0801XOrthopaedic Trauma Physician4001OK
3207X00000XOrthopaedic Surgery Physician4001OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14001OTHEROKMEDICAL LICENSE

General Provider Information

NPI Number : 1578511697
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEREK LYNN WEST DO
Provider Business Mailing Address
First Line : 8100 S WALKER AVE BLDG A
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73139-9475
Country : US
Telephone Number : 405-632-4468
Fax Number : 405-632-0436
Provider Business Practice Location Address
First Line : 8100 S WALKER AVE BLDG A
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73139-9475
Country : US
Telephone Number : 405-632-4468
Fax Number : 405-632-0436
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 07/10/2019

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