Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 750 | WV |
N | 207Q00000X | Family Doctor | 750 | WV |
NPI | 1073735346 |
---|---|
Provider Name | Dr. Dominick Harry Mclain |
First Address | Oak Hill, WV 25901-2044 |
Second Address | Beaver, WV 25813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |