Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 0101050993 | VA |
N | 207K00000X | Allergist & Immunologist | 17847 | WV |
N | 207R00000X | Internist | 0101050993 | VA |
N | 111NI0900X | Internist | 0101050993 | VA |
N | 207R00000X | Internist | 17847 | WV |
N | 111NI0900X | Internist | 17847 | WV |
NPI | 1164529889 |
---|---|
Provider Name | Mr. Donald Walter Asbury |
First Address | Bluefield, VA 24605 |
Second Address | Bluefield, VA 24605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2006 |
Last Update Date | 07/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005855331 | (05) | VA |
0070397000 | MEDICAID (01) | WV |
F63440 | (02) |