Individual
GERT J. VAN DER WESTHUIZEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
130 W RAVINE RD, KINGSPORT, TN 37660-3810
(423) 968-1144
(423) 968-3453
Mailing address
3053 W STATE ST, BRISTOL, TN 37620-1720
(423) 968-1144
(423) 968-3453
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
36151
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
385602
ANTHEM (BCBS VA)
VA
05
—
3872101
—
TN
01
—
4037644
BCBS
TN
01
—
R06903
JOHN DEERE
TN
Enumeration date
08/26/2005
Last updated
07/08/2007
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