Provider Demographics
NPI:1770527962
Name:WEST, PATRICK BLAKE (IDC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:BLAKE
Last Name:WEST
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50A FREEMAN PL
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-1846
Mailing Address - Country:US
Mailing Address - Phone:360-373-4103
Mailing Address - Fax:360-396-4742
Practice Address - Street 1:USS LOUISIANA SSBN 743 (BLUE)
Practice Address - Street 2:2100 THRESHER AVE
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98315-2100
Practice Address - Country:US
Practice Address - Phone:360-315-4206
Practice Address - Fax:360-396-4742
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman