Provider Demographics
NPI:1497534234
Name:WEST, BRANDON LEE (CO)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:LEE
Last Name:WEST
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 W GARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2119
Mailing Address - Country:US
Mailing Address - Phone:509-325-2355
Mailing Address - Fax:509-326-3370
Practice Address - Street 1:3400 W GARLAND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2119
Practice Address - Country:US
Practice Address - Phone:509-325-2355
Practice Address - Fax:509-326-3370
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61464048390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program