Provider Demographics
NPI:1043473598
Name:WEST, JOHN REID SR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:REID
Last Name:WEST
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:20696 BOND RD NE STE 205
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-9025
Mailing Address - Country:US
Mailing Address - Phone:360-930-0222
Mailing Address - Fax:360-210-1429
Practice Address - Street 1:20696 BOND RD NE STE 205
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9025
Practice Address - Country:US
Practice Address - Phone:360-930-0222
Practice Address - Fax:360-210-1429
Is Sole Proprietor?:No
Enumeration Date:2008-07-04
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60694527207XX0005X, 207X00000X
KY46006207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2169137Medicaid