1912091208 NPI number — DR. DON MAURICE WEST M.D.

Table of content: DR. DON MAURICE WEST M.D. (NPI 1912091208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912091208 NPI number — DR. DON MAURICE WEST M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEST
Provider First Name:
DON
Provider Middle Name:
MAURICE
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:
1912091208
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1305 AIRPORT FWY STE 302
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76021-6604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-283-6995
Provider Business Mailing Address Fax Number:
817-952-7011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1305 AIRPORT FWY STE 302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76021-6604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-283-6995
Provider Business Practice Location Address Fax Number:
817-952-7011
Provider Enumeration Date:
10/03/2006

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: 225400000X , with the licence number:  G5762 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4204222 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2035487-03 . This is a "GROUP TPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: D07564 . This is a "RR GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 035411003 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P000QB415 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01239785 . This is a "RAILROAD PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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