MEDICARE: GUNNAR WEST D.O.

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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	H5414	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831196534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUNNAR WEST D.O.

Provider Business Mailing Address
First Line	:	2448 W ILLINOIS AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75233-1106
Country	:	US
Telephone Number	:	214-330-7028
Fax Number	:	214-330-8497

Provider Business Practice Location Address
First Line	:	2909 S HAMPTON RD
Second Line	:	E121 BOX 26
City	:	DALLAS
State	:	TX
Zip	:	75224-3000
Country	:	US
Telephone Number	:	214-330-7028
Fax Number	:	214-330-8497

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/06/2020

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Directions to “ GUNNAR WEST D.O.” Practice Location

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