Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 13309 | WV |
NPI | 1760443162 |
---|---|
Provider Name | Albert James Paine JR. |
First Address | Beckley, WV 25801-6765 |
Second Address | Beckley, WV 25801-6765 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 22/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B42691 | (02) | WV |