Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 1665 | WV |
N | 207QA0401X | Family Doctor - Addiction Medicine | 1665 | WV |
N | 207R00000X | Internist | 1665 | WV |
N | 111NI0900X | Internist | 1665 | WV |
NPI | 1821152182 |
---|---|
Provider Name | Brian Joseph Mcdevitt |
First Address | Chapmanville, WV 25508-0099 |
Second Address | Chapmanville, WV 25508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 09/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5305014000 | (05) | WV |
G95903 | (02) |