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General NPI Number Information
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NPI Number | 1487606117
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Entity Type | Individual
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Provider Name | JOHN ROBERT WEST JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 10/28/2014
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Provider Practice Location Address
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Address Line | 34 WATER STREET SUITE 2
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City | MYSTIC
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State | CT
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Zip | 06355
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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 STREET SUITE 2
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City | MYSTIC
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State | CT
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Zip | 06355
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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 |
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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 | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | G61079
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 44204
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License Number State | CT
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