MEDICARE: STEPHEN M WEST MD LLC

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	207Q00000X	Family Medicine Physician	22031	AL

General Provider Information

NPI Number	:	1386702306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN M WEST MD LLC

Provider Business Mailing Address
First Line	:	680 WEST FRONT ST
Second Line	:
City	:	EVERGREEN
State	:	AL
Zip	:	36401-3005
Country	:	US
Telephone Number	:	251-578-5111
Fax Number	:	251-578-5991

Provider Business Practice Location Address
First Line	:	680 WEST FRONT ST
Second Line	:
City	:	EVERGREEN
State	:	AL
Zip	:	36401-3005
Country	:	US
Telephone Number	:	251-578-5111
Fax Number	:	251-578-5991

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEPHEN WEST
Credential	:	MD
Telephone Number	:	251-578-5111

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	08/22/2020

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