Individual
MR. DOUGLAS A WEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1701 E COLLEGE AVE, BLOOMINGTON, IL 61704-2101
(309) 664-3038
(309) 664-3119
Mailing address
1205 N LIVINGSTON ST, BLOOMINGTON, IL 61701-1534
(309) 838-3640
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096003032
IL
Other
Enumeration date
03/02/2011
Last updated
03/02/2011
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