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NPI Code Detail

MEDICARE: DR. MILTON DEAN HAVRON JR. MD

MEDICARE: DR. MILTON DEAN HAVRON JR. MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician0101055962VA

General Provider Information

NPI Number : 1649274283
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MILTON DEAN HAVRON JR. MD
Provider Business Mailing Address
First Line : 510 BUTLER AVE
Second Line : 413B
City : MARTINSBURG
State : WV
Zip : 25405-9990
Country : US
Telephone Number : 303-263-0811
Fax Number :
Provider Business Practice Location Address
First Line : 510 BUTLER AVE
Second Line :
City : MARTINSBURG
State : WV
Zip : 25405-9990
Country : US
Telephone Number : 304-263-0811
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 02/08/2016

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