Provider Demographics
NPI:1811248933
Name:WEST, MATTHEW GREGORY (PA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GREGORY
Last Name:WEST
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 COMMERCIAL WAY
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-2600
Mailing Address - Country:US
Mailing Address - Phone:775-455-4254
Mailing Address - Fax:775-242-4591
Practice Address - Street 1:50 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-2600
Practice Address - Country:US
Practice Address - Phone:775-455-4254
Practice Address - Fax:775-242-4591
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1381363A00000X
NVPA0419363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
12436250OtherCAQH
NV1811248933Medicaid