Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 2039 | WV |
NPI | 1902892698 |
---|---|
Provider Name | Dr. Philip D High |
First Address | Wheeling, WV 26003-6332 |
Second Address | Wheeling, WV 26003-6332 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0138210000 | (05) | WV |
2039 | LICENSE NO (01) | WV |
T82021 | (02) |