Basic Information
Provider Information
NPI: 1609850197
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WESTERFIELD
FirstName: JOHN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 3002
Address2:  
City: LONGVIEW
State: WA
PostalCode: 986320302
CountryCode: US
TelephoneNumber: 3604142048
FaxNumber: 3605756749
Practice Location
Address1: 1615 DELAWARE ST
Address2: ANESTHESIA DEPT
City: LONGVIEW
State: WA
PostalCode: 986322310
CountryCode: US
TelephoneNumber: 3604142048
FaxNumber: 3605756749
Other Information
ProviderEnumerationDate: 11/30/2005
LastUpdateDate: 01/30/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XMD00037635WAY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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