Individual
TAD W. WESTDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1718 E KESSLER BLVD, LONGVIEW, WA 98632-1842
(360) 747-5800
(360) 575-3846
Mailing address
PO BOX 3002, LONGVIEW, WA 98632-0302
(360) 747-5800
(360) 575-3846
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA60115702
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0255166
LABOR & INDUSTRIES / CRIME VICTIMS
WA
05
—
500618673
—
OR
05
—
8561748
—
WA
01
—
P00844161
RAILROAD MEDICARE
WA
Enumeration date
11/22/2009
Last updated
07/30/2012
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