Healthcare Provider Details

I. General information

NPI: 1295338416
Provider Name (Legal Business Name): J ROBERT WEST, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S RANCHO DR STE E
LAS VEGAS NV
89106-4849
US

IV. Provider business mailing address

9900 N CENTRAL EXPY STE 500
DALLAS TX
75231-0928
US

V. Phone/Fax

Practice location:
  • Phone: 702-258-1001
  • Fax: 702-258-8215
Mailing address:
  • Phone: 214-987-3376
  • Fax: 469-532-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: KARA LYNN FOLEY
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 702-360-2763