Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 10032 | WV |
NPI | 1124082631 |
---|---|
Provider Name | Dr. Guy David Leveaux |
First Address | Shinnston, WV 26431-9613 |
Second Address | Gassaway, WV 26624-9321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 13/01/2021 |