Healthcare Provider Details

I. General information

NPI: 1669457917
Provider Name (Legal Business Name): WILLIAM T WESTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 S NATIONAL AVE
SPRINGFIELD MO
65807-7310
US

IV. Provider business mailing address

3555 S NATIONAL AVE
SPRINGFIELD MO
65807-7310
US

V. Phone/Fax

Practice location:
  • Phone: 417-875-3800
  • Fax: 417-875-3176
Mailing address:
  • Phone: 417-875-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number110630
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: