Provider Demographics
NPI:1043287543
Name:WESTRA, DONALD FREEMAN JR (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:FREEMAN
Last Name:WESTRA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 DOCTORS PARK
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-4406
Mailing Address - Country:US
Mailing Address - Phone:704-732-3346
Mailing Address - Fax:704-732-6863
Practice Address - Street 1:112 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4406
Practice Address - Country:US
Practice Address - Phone:704-732-3346
Practice Address - Fax:704-732-6863
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23891207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891330KMedicaid
NC2014146AMedicare ID - Type Unspecified
NCD54728Medicare UPIN