Individual
JASON WEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
117 E CLARK ST, HARRISBURG, IL 62946
(618) 252-8625
(618) 351-4859
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036148248
IL
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
036148248
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036148248
—
IL
Enumeration date
06/06/2016
Last updated
06/03/2024
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