Provider Demographics
NPI:1548220965
Name:WEST, OSCAR DERMOTT (MD)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:DERMOTT
Last Name:WEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:695 N CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114
Mailing Address - Country:US
Mailing Address - Phone:386-258-8722
Mailing Address - Fax:386-258-8659
Practice Address - Street 1:630 W PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3260
Practice Address - Country:US
Practice Address - Phone:386-734-3654
Practice Address - Fax:386-943-8087
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074665207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256091700Medicaid
FL44356OtherBCBS
FL44356OtherBCBS
FL256091700Medicaid