Provider Demographics
NPI:1801843123
Name:WEST, RICHARD JOE (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOE
Last Name:WEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICKEY
Other - Middle Name:JOE
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1100 ENGLAND DR
Mailing Address - Street 2:UCRO
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-0924
Mailing Address - Country:US
Mailing Address - Phone:931-528-7531
Mailing Address - Fax:931-520-0413
Practice Address - Street 1:251 JOY ALFORD WAY
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-3047
Practice Address - Country:US
Practice Address - Phone:615-735-0242
Practice Address - Fax:615-735-8250
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000014288208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3030363Medicaid
TNB59013Medicare UPIN
TN3030363Medicaid