Provider Demographics
NPI:1013058775
Name:WEST, RICHARD MARK JR (CRT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:MARK
Last Name:WEST
Suffix:JR
Gender:M
Credentials:CRT
Other - Prefix:MR
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRT
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:ROYAL
Mailing Address - State:AR
Mailing Address - Zip Code:71968-0264
Mailing Address - Country:US
Mailing Address - Phone:501-276-0161
Mailing Address - Fax:501-623-8237
Practice Address - Street 1:1910 ALBERT PIKE RD
Practice Address - Street 2:SUITE G & H
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4011
Practice Address - Country:US
Practice Address - Phone:501-623-8520
Practice Address - Fax:501-623-8237
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1537227800000X
ARRCP-15372278P1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary Rehabilitation
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified