Healthcare Provider Details

I. General information

NPI: 1639178106
Provider Name (Legal Business Name): DANNY L WEST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 LIVERMORE DR
PEMBROKE NC
28372-7270
US

IV. Provider business mailing address

102 LIVERMORE DR
PEMBROKE NC
28372-7270
US

V. Phone/Fax

Practice location:
  • Phone: 910-521-8484
  • Fax: 910-521-9765
Mailing address:
  • Phone: 910-521-8484
  • Fax: 910-521-9765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9901355
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: