Provider Demographics
NPI:1598718330
Name:WEST, WILLARD MAHLON (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLARD
Middle Name:MAHLON
Last Name:WEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1425 W BADDOUR PKWY
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2513
Mailing Address - Country:US
Mailing Address - Phone:615-444-1118
Mailing Address - Fax:615-443-0465
Practice Address - Street 1:1425 W BADDOUR PKWY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2513
Practice Address - Country:US
Practice Address - Phone:615-444-1118
Practice Address - Fax:615-443-0465
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD9741207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA110125373OtherRAILROAD MEDICARE
TN3185582Medicaid
GA110125373OtherRAILROAD MEDICARE
TNB04199Medicare UPIN