Provider Demographics
NPI:1033473913
Name:WESTAFER, MICHAEL DEREK (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DEREK
Last Name:WESTAFER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3475 GS RICHARDS BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-8462
Mailing Address - Country:US
Mailing Address - Phone:775-841-2000
Mailing Address - Fax:775-841-4200
Practice Address - Street 1:3475 GS RICHARDS BLVD # 130
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-8462
Practice Address - Country:US
Practice Address - Phone:775-841-2000
Practice Address - Fax:775-841-4200
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA15241207W00000X
OH128338207W00000X
NV17065207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1033473913Medicaid