MEDICARE: NICHOLAS JAMES WESTFALL 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	390200000X	Student in an Organized Health Care Education/Training Program
2	208800000X	Urology Physician	DR.0058838	CO

General Provider Information

NPI Number	:	1538458575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS JAMES WESTFALL M.D.

Provider Business Mailing Address
First Line	:	2373 G RD
Second Line	:	STE 200
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1006
Country	:	US
Telephone Number	:	970-243-3061
Fax Number	:	970-245-8369

Provider Business Practice Location Address
First Line	:	2373 G RD STE 200
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1006
Country	:	US
Telephone Number	:	970-243-3061
Fax Number	:	970-245-8369

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

Provider Enumeration Date	:	03/30/2011
Last Update Date	:	07/21/2022

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