Provider Demographics
NPI:1972611754
Name:WEST, LARRY KETNER (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:KETNER
Last Name:WEST
Suffix:
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:PO BOX 2648
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2648
Mailing Address - Country:US
Mailing Address - Phone:606-432-1357
Mailing Address - Fax:606-432-2457
Practice Address - Street 1:911 SOUTH BY PASS ROAD
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501
Practice Address - Country:US
Practice Address - Phone:606-432-1357
Practice Address - Fax:606-432-2457
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY299892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50001859OtherPASSPORT
WV0216623000Medicaid
KY64299894Medicaid
0958131OtherUMWA GROUP NUMBER
KY000000047646OtherANTHEM
KY64299894Medicaid
WV0216623000Medicaid
KY50001859OtherPASSPORT