Provider Demographics
NPI:1588670475
Name:WEST, STEPHEN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:WEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 WEST FRONT ST
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:AL
Mailing Address - Zip Code:36401-3005
Mailing Address - Country:US
Mailing Address - Phone:251-578-5111
Mailing Address - Fax:251-578-5991
Practice Address - Street 1:680 WEST FRONT ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:AL
Practice Address - Zip Code:36401-3005
Practice Address - Country:US
Practice Address - Phone:251-578-5111
Practice Address - Fax:251-578-5991
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000055018Medicaid
000055018Medicare PIN
ALG91814Medicare UPIN