Provider Demographics
NPI:1548384894
Name:GEORGE G WESTERMAN, MD, CPE, FACPE
Entity Type:Organization
Organization Name:GEORGE G WESTERMAN, MD, CPE, FACPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:GRAYSON
Authorized Official - Last Name:WESTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-341-6411
Mailing Address - Street 1:2580 MONTESSOURI ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3065
Mailing Address - Country:US
Mailing Address - Phone:702-341-6411
Mailing Address - Fax:
Practice Address - Street 1:2580 MONTESSOURI ST
Practice Address - Street 2:C 106
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3066
Practice Address - Country:US
Practice Address - Phone:702-341-6411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A90407Medicare UPIN