Provider Demographics
NPI:1316021967
Name:WESTFALL, JONATHAN MARK (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MARK
Last Name:WESTFALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PLZ
Mailing Address - Street 2:SUITE 325
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-2629
Mailing Address - Country:US
Mailing Address - Phone:205-623-2171
Mailing Address - Fax:205-414-7030
Practice Address - Street 1:1 INDEPENDENCE PLZ
Practice Address - Street 2:SUITE 325
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-2629
Practice Address - Country:US
Practice Address - Phone:205-623-2171
Practice Address - Fax:205-414-7030
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL200872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51109306OtherBLUE CROSS OF ALABAMA
102I263892Medicare PIN
ALF45971Medicare UPIN