Provider Demographics
NPI:1578511697
Name:WEST, DEREK LYNN (DO)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:LYNN
Last Name:WEST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 S WALKER AVE BLDG A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9475
Mailing Address - Country:US
Mailing Address - Phone:405-632-4468
Mailing Address - Fax:405-632-0436
Practice Address - Street 1:8100 S WALKER AVE BLDG A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9475
Practice Address - Country:US
Practice Address - Phone:405-632-4468
Practice Address - Fax:405-632-0436
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4001207XX0005X, 207XX0801X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4001OtherMEDICAL LICENSE
OKH98305Medicare UPIN
OK200019290AMedicaid
OK247619201Medicare PIN