Provider Demographics
NPI:1578001517
Name:WEST, PETER (LAC)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:WEST
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 NEW ORLEANS RD
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928-4715
Mailing Address - Country:US
Mailing Address - Phone:843-683-4584
Mailing Address - Fax:
Practice Address - Street 1:30 NEW ORLEANS RD
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-4715
Practice Address - Country:US
Practice Address - Phone:843-683-4584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC054171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist