Healthcare Provider Details

I. General information

NPI: 1750379053
Provider Name (Legal Business Name): STEVEN J WESTGATE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BUSINESS LOOP 70 W
COLUMBIA MO
65203-3244
US

IV. Provider business mailing address

1705 E BROADWAY SUITE 100
COLUMBIA MO
65201-5852
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-8644
  • Fax: 573-882-8817
Mailing address:
  • Phone: 573-874-7800
  • Fax: 573-443-3627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberR5G99
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: