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General NPI Number Information
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NPI Number | 1407088081
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Entity Type | Organization
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Legal Business Name | J. ROBERT WEST, M.D., INC
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Dates
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Enumeration Date | 08/17/2009
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 1729 N TREKELL RD STE 124
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City | CASA GRANDE
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State | AZ
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Zip | 85122-2215
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Country | US
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Telephone | 520-421-7100
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Fax | 520-421-1300
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Provider Business Mailing Address
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Address Line | 12700 PARK CENTRAL DR STE 1210
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City | DALLAS
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State | TX
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Zip | 75251-1522
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Country | US
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Telephone | 702-360-2763
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Fax | 949-783-2880
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | LUCIUS BLANCHARD
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Credential | M.D.
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Telephone | 702-360-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 40312
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License Number State | AZ
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