Provider Demographics
NPI:1649680638
Name:ROBERT WEST LC
Entity type:Organization
Organization Name:ROBERT WEST LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:314-720-0050
Mailing Address - Street 1:15510 OLIVE BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-0710
Mailing Address - Country:US
Mailing Address - Phone:314-720-0050
Mailing Address - Fax:314-787-2133
Practice Address - Street 1:15510 OLIVE BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-0710
Practice Address - Country:US
Practice Address - Phone:314-720-0050
Practice Address - Fax:314-787-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014010407208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty