Provider Demographics
NPI:1538239967
Name:WEST, TOD A JR (NP)
Entity type:Individual
Prefix:MR
First Name:TOD
Middle Name:A
Last Name:WEST
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2457 SHETLAND DR
Mailing Address - Street 2:
Mailing Address - City:DARDENNE PRAIRIE
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7213
Mailing Address - Country:US
Mailing Address - Phone:636-294-1088
Mailing Address - Fax:
Practice Address - Street 1:10805 SUNSET OFFICE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1017
Practice Address - Country:US
Practice Address - Phone:314-238-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106881363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily