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General NPI Number Information
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NPI Number | 1376575324
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Entity Type | Organization
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Legal Business Name | JOHN R. WEST MD INC
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 02/06/2013
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Provider Practice Location Address
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Address Line | 34 WATER ST SUITE 2
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City | MYSTIC
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State | CT
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Zip | 06355-2524
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Country | US
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Telephone | 860-572-9994
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Fax | 860-572-9930
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Provider Business Mailing Address
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Address Line | 34 WATER ST # 2
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City | MYSTIC
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State | CT
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Zip | 06355-2524
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Country | US
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Telephone | 860-572-9994
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Fax | 860-572-9930
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN ROBERT WEST JR.
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Credential | M.D.
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Telephone | 860-572-9994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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