Healthcare Provider Details

I. General information

NPI: 1043473598
Provider Name (Legal Business Name): JOHN REID WEST SR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2008
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20696 BOND RD NE STE 205
POULSBO WA
98370-9025
US

IV. Provider business mailing address

20696 BOND RD NE STE 205
POULSBO WA
98370-9025
US

V. Phone/Fax

Practice location:
  • Phone: 360-930-0222
  • Fax: 360-210-1429
Mailing address:
  • Phone: 360-930-0222
  • Fax: 360-210-1429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD60694527
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD60694527
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: