Provider Demographics
NPI:1407895071
Name:WESTBROOK, KENNETH LEROY (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:LEROY
Last Name:WESTBROOK
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 1:2830 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4331
Mailing Address - Country:US
Mailing Address - Phone:559-636-1000
Mailing Address - Fax:559-733-7438
Practice Address - Street 1:2830 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4331
Practice Address - Country:US
Practice Address - Phone:559-636-1000
Practice Address - Fax:559-733-7438
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC27713207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC27713OtherMEDICAL LICENSE
CAA33444Medicare UPIN
CAC27713OtherMEDICAL LICENSE