1205856358 NPI number — DR. ROBERT ALAN WESTEFER M.D.

Table of content: DR. ROBERT ALAN WESTEFER M.D. (NPI 1205856358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205856358 NPI number — DR. ROBERT ALAN WESTEFER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WESTEFER
Provider First Name:
ROBERT
Provider Middle Name:
ALAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205856358
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6915 N KNOXVILLE AVE
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61614-2850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-691-1259
Provider Business Mailing Address Fax Number:
309-683-8911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6915 N KNOXVILLE AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61614-2850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-691-1259
Provider Business Practice Location Address Fax Number:
309-683-8911
Provider Enumeration Date:
07/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0007223615 . This is a "BCBS PROVIDER ID#" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 009045 . This is a "HEALTH ALLIANCE PROVIDER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: IL0102 . This is a "JOHN DEERE PROVIDER ID#" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 166141 . This is a "HEALTHLINK PROVIDER ID#" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".