Provider Demographics
NPI:1235390337
Name:WESTFALL, LINCOLN JON (DO)
Entity Type:Individual
Prefix:
First Name:LINCOLN
Middle Name:JON
Last Name:WESTFALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 E HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-8631
Mailing Address - Country:US
Mailing Address - Phone:509-682-3300
Mailing Address - Fax:
Practice Address - Street 1:803 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-2383
Practice Address - Country:US
Practice Address - Phone:509-837-6911
Practice Address - Fax:509-837-6920
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60107448207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
09281980OtherWIFE'S BIRTHDATE
WAWESTFLJ239KFOtherDRIVER'S LICENSE