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NPI Code Detail

MEDICARE: MR. MARVIN R WEST P.A.

MEDICARE: MR. MARVIN R WEST P.A.
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
1363A00000XPhysician AssistantPA 1584FL

General Provider Information

NPI Number : 1356569461
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARVIN R WEST P.A.
Provider Business Mailing Address
First Line : 8942 ELIZABETH FALLS DR
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32257-5379
Country : US
Telephone Number : 904-891-0958
Fax Number :
Provider Business Practice Location Address
First Line : 10175 FORTUNE PKWY UNIT 803
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-6754
Country : US
Telephone Number : 904-374-0353
Fax Number : 904-503-0982
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2007
Last Update Date : 04/09/2024

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