Provider Demographics
NPI:1861650731
Name:WEST, TIMOTHY WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:WILLIAM
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 1:370 E 9TH AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3182
Mailing Address - Country:US
Mailing Address - Phone:801-408-5700
Mailing Address - Fax:801-408-5704
Practice Address - Street 1:370 E 9TH AVE STE 106
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-3182
Practice Address - Country:US
Practice Address - Phone:801-408-5700
Practice Address - Fax:801-408-5704
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1035772084N0400X
UT371866-12052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB224563Medicare UPIN
NVVWQBHVMedicare UPIN