Jackie W. Westfall D.O. LLC

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

OS5855 Issued in FL

Legal business name

JACKIE W. WESTFALL D.O. LLC

Practice address

322 Racetrack Rd NE
Fort Walton Beach, FL 32547-2546

Phone

(850) 682-5332

Fax

(850) 683-5333

NPI assigned

Jun 14, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jackie W. Westfall, D.O.

Title

President

Phone

(850) 682-5332

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308009600000",
    "number": "1740575158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 RACETRACK RD NE",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325472546",
            "telephone_number": "850-682-5332",
            "fax_number": "850-683-5333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 RACETRACK RD NE",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325472546",
            "telephone_number": "850-682-5332",
            "fax_number": "850-683-5333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKIE W. WESTFALL D.O. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-14",
        "last_updated": "2011-06-14",
        "status": "A",
        "authorized_official_last_name": "WESTFALL",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-682-5332",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "FL",
            "license": "OS5855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Exclusive Provider Organization in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Exclusive Provider Organization in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.