Provider Demographics
NPI:1174549695
Name:WEST, KEVIN BRUCE (MD MPH)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BRUCE
Last Name:WEST
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Gender:M
Credentials:MD MPH
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Mailing Address - Street 1:100 PAUL WAGNER DR
Mailing Address - Street 2:BLDG 1730 ATTN CREDENTIALS CMC CHARNELL MCDONALD
Mailing Address - City:KELLY USA
Mailing Address - State:TX
Mailing Address - Zip Code:78241
Mailing Address - Country:US
Mailing Address - Phone:210-925-0321
Mailing Address - Fax:210-925-0327
Practice Address - Street 1:1515 TRUEMPER
Practice Address - Street 2:BLDG 6612
Practice Address - City:LACKLAND A F B
Practice Address - State:TX
Practice Address - Zip Code:78236-5550
Practice Address - Country:US
Practice Address - Phone:210-671-9654
Practice Address - Fax:210-671-6480
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2008-05-22
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Provider Licenses
StateLicense IDTaxonomies
TXM21962083A0100X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine