Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 15460 | WV |
Y | 2084N0400X | Neurologist | 15460 | WV |
NPI | 1295799245 |
---|---|
Provider Name | Dr. Joby Joseph |
First Address | Charleston, WV 25301-1853 |
Second Address | Charleston, WV 25301-1853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 11/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0089881000 | (05) | WV |
F11021 | (02) | |
JO4042151 | (02) | WV |