Healthcare Provider Details

I. General information

NPI: 1760625818
Provider Name (Legal Business Name): RYAN B. WEST, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2009
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 LINVILLE DR
PARIS KY
40361-2128
US

IV. Provider business mailing address

6 LINVILLE DR
PARIS KY
40361-2128
US

V. Phone/Fax

Practice location:
  • Phone: 859-987-3710
  • Fax: 859-987-8583
Mailing address:
  • Phone: 859-987-3710
  • Fax: 859-987-8583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number42507
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number42507
License Number StateKY

VIII. Authorized Official

Name: RYAN B WEST
Title or Position: OWNER
Credential: MD
Phone: 859-987-3710