Provider Demographics
NPI:1346392073
Name:WEST, TODD BROOKE (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:BROOKE
Last Name:WEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 5TH AVE E
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-7421
Mailing Address - Country:US
Mailing Address - Phone:205-348-6262
Mailing Address - Fax:
Practice Address - Street 1:750 5TH AVE E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-7421
Practice Address - Country:US
Practice Address - Phone:205-348-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.33604207Q00000X
TXP6550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-50514OtherBLUE CROSS BLUE SHIELD OF ALABAMA
GA202I933622Medicare PIN
TX8DT114OtherBCBS