Healthcare Provider Details

I. General information

NPI: 1407836406
Provider Name (Legal Business Name): CHARLES B WEST JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 N PARK ST
ASHEBORO NC
27203-5440
US

IV. Provider business mailing address

P.O. BOX 5418
ASHEBORO NC
27204-5418
US

V. Phone/Fax

Practice location:
  • Phone: 336-625-1007
  • Fax: 336-625-0350
Mailing address:
  • Phone: 336-625-2333
  • Fax: 336-625-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number38463
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: