Individual
DR. JOHN ROBERT WEST JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
34 WATER STREET, SUITE 2, MYSTIC, CT 06355
(860) 572-9994
(860) 572-9930
Mailing address
34 WATER STREET, SUITE 2, MYSTIC, CT 06355
(860) 572-9994
(860) 572-9930
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
44204
CT
207ND0101X
MOHS-Micrographic Surgery Physician
G61079
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010044204CT01
BLUE CROSS BLUE SHIELD
CT
Enumeration date
05/17/2006
Last updated
10/28/2014
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