Provider Demographics
NPI:1386668028
Name:WEST, RONALD A (PA)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:WEST
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:4234 LARKSPUR TRACE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-1312
Mailing Address - Country:US
Mailing Address - Phone:317-573-7733
Mailing Address - Fax:317-573-7739
Practice Address - Street 1:13431 OLD MERIDIAN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7101
Practice Address - Country:US
Practice Address - Phone:317-573-7733
Practice Address - Fax:317-573-7739
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2010-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN1000097A363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INR61498Medicare UPIN
IN313400FMedicare PIN
IN970012310Medicare PIN