Provider Demographics
NPI:1306036165
Name:WEST GADSDEN MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:WEST GADSDEN MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:RICARDO
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-546-9231
Mailing Address - Street 1:1017 WEST MEIGHAN BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-3329
Mailing Address - Country:US
Mailing Address - Phone:256-546-9231
Mailing Address - Fax:256-546-9241
Practice Address - Street 1:1017 WEST MEIGHAN BOULEVARD
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-3329
Practice Address - Country:US
Practice Address - Phone:256-546-9231
Practice Address - Fax:256-546-9241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL09296207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B04788Medicare UPIN