Healthcare Provider Details

I. General information

NPI: 1295894442
Provider Name (Legal Business Name): MARK D WEST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 03/07/2020
Certification Date: 03/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 HOSPITAL DR
MOUNTAIN HOME AR
72653-2955
US

IV. Provider business mailing address

PO BOX 1449
MOUNTAIN HOME AR
72654-1449
US

V. Phone/Fax

Practice location:
  • Phone: 870-508-1000
  • Fax:
Mailing address:
  • Phone: 870-424-3181
  • Fax: 870-424-3089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC-7164
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number07428R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: