Provider Demographics
NPI:1326019944
Name:WEST, CARL G (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:G
Last Name:WEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:47674 CALEO BAY DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-8856
Mailing Address - Country:US
Mailing Address - Phone:760-673-7010
Mailing Address - Fax:760-673-7911
Practice Address - Street 1:47674 CALEO BAY DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LAQUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-8856
Practice Address - Country:US
Practice Address - Phone:760-673-7010
Practice Address - Fax:760-673-7911
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY201148207RG0100X
CAG35020207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A46185Medicare UPIN