Healthcare Provider Details

I. General information

NPI: 1295917904
Provider Name (Legal Business Name): J. ROBERT WEST, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14785 JEFFREY RD SUITE 201
IRVINE CA
92618-0408
US

IV. Provider business mailing address

12700 PARK CENTRAL DR STE 1210
DALLAS TX
75251-1522
US

V. Phone/Fax

Practice location:
  • Phone: 949-653-0280
  • Fax: 949-653-0200
Mailing address:
  • Phone: 702-360-2763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberG4302
License Number StateCA

VIII. Authorized Official

Name: KARA LYNN FOLEY
Title or Position: CREDENTIALING
Credential:
Phone: 702-360-2763