Provider Demographics
NPI:1538276191
Name:WEST, FLAVIA H (MD)
Entity type:Individual
Prefix:MRS
First Name:FLAVIA
Middle Name:H
Last Name:WEST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:FLAVIA
Other - Middle Name:H
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO DRAWER 450
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863
Mailing Address - Country:US
Mailing Address - Phone:662-489-5038
Mailing Address - Fax:662-489-7004
Practice Address - Street 1:183 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-3209
Practice Address - Country:US
Practice Address - Phone:662-489-5038
Practice Address - Fax:662-489-7004
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00019567Medicaid
MS00019567Medicaid
B30181Medicare UPIN