Basic Information
| Provider Information | |||||||||
| NPI: | 1760479133 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIVEN | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | DOUGLAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 617 RIVER ST | ||||||||
| Address2: | |||||||||
| City: | GASSAWAY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 266241137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043648941 | ||||||||
| FaxNumber: | 3043648943 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 HOYLMAN DRIVE | ||||||||
| Address2: | |||||||||
| City: | GASSAWAY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 266241137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043645156 | ||||||||
| FaxNumber: | 3043641188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 04/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 13986 | WV | N | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | 13986 | WV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00658278 | 01 | WV | RR MEDICARE | OTHER | 0057134000 | 05 | WV | MEDICAID |