Provider Demographics
NPI:1356368955
Name:WEST, BRITTON R (MD)
Entity type:Individual
Prefix:
First Name:BRITTON
Middle Name:R
Last Name:WEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-924-9960
Practice Address - Street 1:1420 8TH AVENUE
Practice Address - Street 2:SUITE 103
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4138
Practice Address - Country:US
Practice Address - Phone:817-924-9002
Practice Address - Fax:817-924-9960
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5092208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099030103Medicaid
280001171OtherRAILROAD MEDICARE
C23359Medicare UPIN