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General NPI Number Information
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NPI Number | 1760831218
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Entity Type | Individual
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Provider Name | JASON WEST M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2016
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 117 E CLARK ST
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City | HARRISBURG
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State | IL
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Zip | 62946
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Country | US
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Telephone | 618-252-8625
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Fax | 618-351-4859
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Provider Business Mailing Address
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Address Line | PO BOX 3988
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City | CARBONDALE
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State | IL
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Zip | 62902-3988
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Country | US
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Telephone | 618-457-5200
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Fax |
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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 | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number | 036148248
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036148248
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License Number State | IL
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