MEDICARE: MR. VICTOR JOSEPH WEST

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1427697671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VICTOR JOSEPH WEST

Provider Business Mailing Address
First Line	:	9932 PYRITE DR
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76131-4341
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9932 PYRITE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-4341
Country	:	US
Telephone Number	:	817-542-9025
Fax Number	:

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

Provider Enumeration Date	:	01/04/2020
Last Update Date	:	01/04/2020

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Directions to “ MR. VICTOR JOSEPH WEST ” Practice Location

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