Provider Demographics
NPI:1962017806
Name:WEST, GARY ALLEN
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:ALLEN
Last Name:WEST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43223 TOWNSHIP ROAD 296
Mailing Address - Street 2:
Mailing Address - City:DRESDEN
Mailing Address - State:OH
Mailing Address - Zip Code:43821-9634
Mailing Address - Country:US
Mailing Address - Phone:740-216-9973
Mailing Address - Fax:
Practice Address - Street 1:43223 TOWNSHIP ROAD 296
Practice Address - Street 2:
Practice Address - City:DRESDEN
Practice Address - State:OH
Practice Address - Zip Code:43821-9634
Practice Address - Country:US
Practice Address - Phone:740-823-2209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health