Provider Demographics
NPI:1770542748
Name:WEST, JOHN HILL JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:HILL
Last Name:WEST
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 INDIAN ROCKS RD S
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-1030
Mailing Address - Country:US
Mailing Address - Phone:727-586-2273
Mailing Address - Fax:727-584-5966
Practice Address - Street 1:1835 INDIAN ROCKS RD S
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-1030
Practice Address - Country:US
Practice Address - Phone:727-586-2273
Practice Address - Fax:727-584-5966
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME18665174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00196450OtherRAILROAD MEDICARE
FL004888000Medicaid
FLP00196450OtherRAILROAD MEDICARE
FL71290ZMedicare ID - Type Unspecified