Provider Demographics
NPI:1699751933
Name:WESTBROOK, JAMES E (PA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:WESTBROOK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:1370 WEST D STREET
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:28659-0609
Mailing Address - Country:US
Mailing Address - Phone:336-651-8100
Mailing Address - Fax:
Practice Address - Street 1:1370 WEST D STREET
Practice Address - Street 2:EMERGENCY DEPT.
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3506
Practice Address - Country:US
Practice Address - Phone:336-651-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100222363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
R63446Medicare UPIN
NC2743143Medicare ID - Type Unspecified