Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AT001457 | WV |
Y | 213ES0000X | Sports Medicine | AT001457 | WV |
NPI | 1538666284 |
---|---|
Provider Name | Jared Muth |
First Address | Huntington, WV 25701-3623 |
Second Address | Huntington, WV 25755-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2018 |
Last Update Date | 10/04/2018 |