Healthcare Provider Details

I. General information

NPI: 1932339298
Provider Name (Legal Business Name): ELLEN B WEST M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEN B LITTLE M.D.

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 HICKORY ST SUITE 102
ABILENE TX
79601-2325
US

IV. Provider business mailing address

3650 E LAKE RD
ABILENE TX
79601-4833
US

V. Phone/Fax

Practice location:
  • Phone: 325-677-2801
  • Fax: 325-677-9110
Mailing address:
  • Phone: 325-660-5095
  • Fax: 325-677-9110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK5605
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: