Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | NA | WV |
NPI | 1073517983 |
---|---|
Provider Name | Dr. David William Goetz |
First Address | Fairmont, WV 26554-9375 |
Second Address | Morgantown, WV 26505-2848 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2005 |
Last Update Date | 04/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0070421000 | (05) | WV |
H39825 | (02) | WV |