Provider Demographics
NPI:1386618478
Name:WESTER, DAVID EUGENE (PA-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:EUGENE
Last Name:WESTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 E PLANK RD
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-8757
Mailing Address - Country:US
Mailing Address - Phone:815-752-3253
Mailing Address - Fax:815-752-3277
Practice Address - Street 1:165 E PLANK RD
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-8757
Practice Address - Country:US
Practice Address - Phone:815-752-3253
Practice Address - Fax:815-752-3277
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
085001296363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S94377Medicare UPIN
563640Medicare ID - Type Unspecified
ILIL8759001Medicare PIN
ILIL2556001Medicare PIN
ILIL8579001Medicare PIN