MEDICARE: GARY W WEST M.D.

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	174400000X	Specialist	F9064	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	300018333	OTHER	TX	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376541250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY W WEST M.D.

Provider Business Mailing Address
First Line	:	19424 STRAUSS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78256-2031
Country	:	US
Telephone Number	:	210-698-9622
Fax Number	:

Provider Business Practice Location Address
First Line	:	8038 WURZBACH RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3812
Country	:	US
Telephone Number	:	210-616-0866
Fax Number	:	210-616-0868

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	07/24/2008

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