MEDICARE: MR. R WEST PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1275984288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. R WEST PA

Provider Business Mailing Address
First Line	:	15411 W WADDELL RD STE 102
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85379-5170
Country	:	US
Telephone Number	:	623-396-6840
Fax Number	:

Provider Business Practice Location Address
First Line	:	15411 W WADDELL RD STE 102
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85379-5170
Country	:	US
Telephone Number	:	623-396-6840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2016
Last Update Date	:	10/14/2025

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Directions to “ MR. R WEST PA” Practice Location

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