Healthcare Provider Details

I. General information

NPI: 1386668028
Provider Name (Legal Business Name): RONALD A WEST PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13431 OLD MERIDIAN ST SUITE 200
CARMEL IN
46032-7101
US

IV. Provider business mailing address

4234 LARKSPUR TRACE
INDIANAPOLIS IN
46237-1312
US

V. Phone/Fax

Practice location:
  • Phone: 317-573-7733
  • Fax: 317-573-7739
Mailing address:
  • Phone: 317-573-7733
  • Fax: 317-573-7739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1000097A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: