| NPI | 1629004221 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY BROOKE TAYLOR Administrative Assistant 304-743-8007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: WV 14713) |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine (Licence: WV 21327) |
| 207QG0300X Family Medicine Geriatric Medicine (Licence: WV 1601) | |
| 207QG0300X Family Medicine Geriatric Medicine (Licence: WV 20005) | |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2020-08-22 |