Organization
JOHN R. WEST MD INC
Active
Other names
Seaport Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN ROBERT WEST JR. M.D. (PRESIDENT)
(860) 572-9994
Entity
Organization
Contact information
Practice address
34 WATER ST, SUITE 2, MYSTIC, CT 06355-2524
(860) 572-9994
(860) 572-9930
Mailing address
34 WATER ST # 2, MYSTIC, CT 06355-2524
(860) 572-9994
(860) 572-9930
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010044204CT01
BLUE CROSS BLUE SHIELD
CT
Enumeration date
07/07/2006
Last updated
02/06/2013
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