1295338416 NPI number — J ROBERT WEST, M.D., INC

Table of content: (NPI 1295338416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295338416 NPI number — J ROBERT WEST, M.D., INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J ROBERT WEST, M.D., INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAS VEGAS SKIN AND CANCER CLINICS
Provider Other Organization Name Type Code:
3
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:
1295338416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12700 PARK CENTRAL DR STE 1210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75251-1522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-360-2763
Provider Business Mailing Address Fax Number:
949-783-2880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 S RANCHO DR STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89106-4849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-258-1001
Provider Business Practice Location Address Fax Number:
702-258-8215
Provider Enumeration Date:
11/19/2020

Additional Information

Authorized Official

Authorized Official Last Name:
FOLEY
Authorized Official First Name:
KARA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
702-360-2763

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ND0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207NS0135X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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