Provider Demographics
NPI: | 1942495924 |
---|---|
Name: | PAUL R. WEST, DO |
Entity Type: | Organization |
Organization Name: | PAUL R. WEST, DO |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | PAUL |
Authorized Official - Middle Name: | R |
Authorized Official - Last Name: | WEST |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DO |
Authorized Official - Phone: | 304-422-2390 |
Mailing Address - Street 1: | 2003 MURDOCH AVE |
Mailing Address - Street 2: | SUITE A |
Mailing Address - City: | PARKERSBURG |
Mailing Address - State: | WV |
Mailing Address - Zip Code: | 26101-2566 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 304-422-2390 |
Mailing Address - Fax: | 304-422-2391 |
Practice Address - Street 1: | 2003 MURDOCH AVE |
Practice Address - Street 2: | SUITE A |
Practice Address - City: | PARKERSBURG |
Practice Address - State: | WV |
Practice Address - Zip Code: | 26101-2566 |
Practice Address - Country: | US |
Practice Address - Phone: | 304-422-2390 |
Practice Address - Fax: | 304-422-2391 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-09-12 |
Last Update Date: | 2007-09-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WV | 974 | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty |