Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 4188 | WV |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 26631 | WV |
NPI | 1487817391 |
---|---|
Provider Name | Dr. Mae A. Hyre |
First Address | Charleston, WV 25302-3390 |
Second Address | Charleston, WV 25301-1842 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2008 |
Last Update Date | 21/12/2015 |