Healthcare Provider Details

I. General information

NPI: 1366686180
Provider Name (Legal Business Name): JOHN EDWARD STRANGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 3RD AVE E
BIG STONE GAP VA
24219-3114
US

IV. Provider business mailing address

1520 3RD AVE E
BIG STONE GAP VA
24219-3114
US

V. Phone/Fax

Practice location:
  • Phone: 276-524-1906
  • Fax: 276-524-1908
Mailing address:
  • Phone: 276-524-1906
  • Fax: 276-524-1908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD23495
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101051572
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: