Basic Information
| Provider Information | |||||||||
| NPI: | 1003305541 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVEE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | MAXWELL | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 MACCORKLE AVE SE STE B16 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253041297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043885848 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3200 MACCORKLE AVE SE STE B16 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253041297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043885848 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2018 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | WV | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 3753 | WV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.