Provider Demographics
NPI:1376541250
Name:WEST, GARY W (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:W
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 1:19424 STRAUSS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-2031
Mailing Address - Country:US
Mailing Address - Phone:210-698-9622
Mailing Address - Fax:
Practice Address - Street 1:8038 WURZBACH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3812
Practice Address - Country:US
Practice Address - Phone:210-616-0866
Practice Address - Fax:210-616-0868
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9064174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110217004Medicaid
TX300018333OtherRR MEDICARE
TX8A0577Medicare PIN
TX110217004Medicaid