Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 21616 | WV |
NPI | 1407840978 |
---|---|
Provider Name | Dr. Tyshaun M James-Hart |
First Address | Hinton, WV 25951-0009 |
Second Address | Beckley, WV 25801-3140 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 19/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000056944C | HUMANA (01) | WV |
001723603 | MOUNTAIN STATE BLUE CROSS (01) | WV |
3810001300 | (05) | WV |
G55459 | (02) | WV |
P00380544 | RAILROAD MEDICARE PIN # (01) | WV |