Provider Demographics
NPI:1639178106
Name:WEST, DANNY L (MD)
Entity Type:Individual
Prefix:MR
First Name:DANNY
Middle Name:L
Last Name:WEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 LIVERMORE DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7270
Mailing Address - Country:US
Mailing Address - Phone:910-521-8484
Mailing Address - Fax:910-521-9765
Practice Address - Street 1:102 LIVERMORE DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7270
Practice Address - Country:US
Practice Address - Phone:910-521-8484
Practice Address - Fax:910-521-9765
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9901355207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC129YXOtherBCBS ID
NC89129YXMedicaid
NC2285782AOtherMEDICARE NUMBER
NCH35742Medicare UPIN