Healthcare Provider Details

I. General information

NPI: 1932401890
Provider Name (Legal Business Name): DAVID M. WEST MD PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 11/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 KENTUCKY AVE SUITE 102
PADUCAH KY
42003-3817
US

IV. Provider business mailing address

PO BOX 9150
PADUCAH KY
42002-9150
US

V. Phone/Fax

Practice location:
  • Phone: 270-443-0202
  • Fax: 270-443-0235
Mailing address:
  • Phone: 270-744-9600
  • Fax: 270-744-0834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number24434
License Number StateKY

VIII. Authorized Official

Name: DR. DAVID M WEST
Title or Position: OWNER
Credential: MD
Phone: 270-443-0202