Provider Demographics
NPI:1730186917
Name:VISHER-WEST, LYNDA (DO)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:VISHER-WEST
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 S HAMPTON RD
Mailing Address - Street 2:SUITE E121 BOX 26
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-3000
Mailing Address - Country:US
Mailing Address - Phone:214-330-9090
Mailing Address - Fax:214-330-8497
Practice Address - Street 1:2909 S HAMPTON RD
Practice Address - Street 2:SUITE E121 BOX 26
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-3000
Practice Address - Country:US
Practice Address - Phone:214-330-9090
Practice Address - Fax:214-330-8497
Is Sole Proprietor?:No
Enumeration Date:2005-07-04
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2880207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099125901Medicaid
TX099125901Medicaid
TXC94610Medicare UPIN