MEDICARE: DR. JERRY DUKE WESTERFIELD RADIOLOGISTS

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	2085R0202X	Diagnostic Radiology Physician	14879	KY

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	:	1740279405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY DUKE WESTERFIELD RADIOLOGISTS

Provider Business Mailing Address
First Line	:	43 DOWELL RD
Second Line	:
City	:	RUSSELL SPRINGS
State	:	KY
Zip	:	42642-4236
Country	:	US
Telephone Number	:	270-866-4868
Fax Number	:	270-866-4809

Provider Business Practice Location Address
First Line	:	43 DOWELL RD
Second Line	:
City	:	RUSSELL SPRINGS
State	:	KY
Zip	:	42642-4236
Country	:	US
Telephone Number	:	270-866-4868
Fax Number	:	270-866-4809

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	12/12/2007

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