MEDICARE: MR. TOD A WEST JR. N.P.

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	363LF0000X	Family Nurse Practitioner	106881	MO

General Provider Information

NPI Number	:	1538239967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TOD A WEST JR. N.P.

Provider Business Mailing Address
First Line	:	2457 SHETLAND DR
Second Line	:
City	:	DARDENNE PRAIRIE
State	:	MO
Zip	:	63368-7213
Country	:	US
Telephone Number	:	636-294-1088
Fax Number	:

Provider Business Practice Location Address
First Line	:	10805 SUNSET OFFICE DR
Second Line	:	SUITE 300
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1017
Country	:	US
Telephone Number	:	314-238-1337
Fax Number	:

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/08/2007

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