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General NPI Number Information
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NPI Number | 1093086589
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Entity Type | Individual
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Provider Name | ROBERT SUMNER WEST M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/16/2012
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Last Update Date | 01/16/2012
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Provider Practice Location Address
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Address Line | 3621 W FAIRWAY DR
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City | COEUR D ALENE
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State | ID
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Zip | 83815-9049
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Country | US
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Telephone | 208-765-0714
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Fax | 209-664-8238
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Provider Business Mailing Address
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Address Line | 212 W IRONWOOD DR STE D, PMB 166
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City | COEUR D ALENE
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State | ID
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Zip | 83814-1403
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Country | US
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Telephone | 208-664-8238
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Fax | 208-664-8238
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | M 2875
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License Number State | ID
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