Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 11591 | WV |
N | 111NI0900X | Internist | 11591 | WV |
Y | 207RG0100X | Gastroenterologist | 11591 | WV |
NPI | 1023044195 |
---|---|
Provider Name | Brittain Mcjunkin |
First Address | Charleston, WV 25304-1210 |
Second Address | Charleston, WV 25304-1210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 03/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001720244 | BLUE CROSS BLUE SHIELD (01) | |
0088270000 | (05) | WV |
100016116 | RAILROAD MEDICARE (01) | |
A72006 | (02) | |
P00419463 | RAILROAD MEDICARE (01) | WV |