Healthcare Provider Details

I. General information

NPI: 1639811250
Provider Name (Legal Business Name): AUSTIN M WEST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 W MILLER ST
ORLANDO FL
32806-2036
US

IV. Provider business mailing address

1055 ADA ST
SAN ANTONIO TX
78223-1703
US

V. Phone/Fax

Practice location:
  • Phone: 407-649-6876
  • Fax: 407-872-0544
Mailing address:
  • Phone: 210-358-5515
  • Fax: 210-358-5530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberV9174
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: