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General NPI Number Information
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NPI Number | 1417902545
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Entity Type | Individual
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Provider Name | GARY WEST PA
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Gender | Male
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 10/17/2007
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Provider Practice Location Address
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Address Line | 615 E 14TH ST
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City | WAYNE
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State | NE
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Zip | 68787-1152
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Country | US
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Telephone | 402-375-2500
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Fax | 402-375-2463
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Provider Business Mailing Address
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Address Line | PO BOX 328
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City | SIOUX CITY
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State | IA
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Zip | 51102-0328
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Country | US
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Telephone | 712-279-5830
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Fax | 712-279-5883
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 56
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License Number State | NE
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