Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 1616 | WV |
NPI | 1780713438 |
---|---|
Provider Name | Debra Lynn Price |
First Address | Charleston, WV 25311-1006 |
Second Address | Charleston, WV 25311-1006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |