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General NPI Number Information
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NPI Number | 1649680638
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Entity Type | Organization
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Legal Business Name | ROBERT WEST LC
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Dates
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Enumeration Date | 04/30/2014
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Last Update Date | 05/19/2015
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Provider Practice Location Address
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Address Line | 15510 OLIVE BLVD SUITE 115
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City | CHESTERFIELD
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State | MO
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Zip | 63017-0710
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Country | US
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Telephone | 314-720-0050
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Fax | 314-787-2133
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Provider Business Mailing Address
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Address Line | 15510 OLIVE BLVD SUITE 115
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City | CHESTERFIELD
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State | MO
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Zip | 63017-0710
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Country | US
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Telephone | 314-720-0050
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Fax | 314-787-2133
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT MICHAEL WEST
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Credential | D.O.
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Telephone | 314-720-0050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 2014010407
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License Number State | MO
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