Provider Demographics
NPI:1093739138
Name:WEST, ROGER F JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:F
Last Name:WEST
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:450 E 96TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-3797
Mailing Address - Country:US
Mailing Address - Phone:317-566-1000
Mailing Address - Fax:317-566-1700
Practice Address - Street 1:8111 S EMERSON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8601
Practice Address - Country:US
Practice Address - Phone:317-566-1000
Practice Address - Fax:317-566-1700
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01036300207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100099070Medicaid
IN227370LMedicare PIN
INE42528Medicare UPIN