Healthcare Provider Details

I. General information

NPI: 1275598989
Provider Name (Legal Business Name): DOUGLAS RAY EITEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 12/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RAILROAD AVENUE
ALDERSON WV
24910
US

IV. Provider business mailing address

PO BOX 147
ALDERSON WV
24910-0147
US

V. Phone/Fax

Practice location:
  • Phone: 304-646-0980
  • Fax: 866-810-8976
Mailing address:
  • Phone: 719-776-0933
  • Fax: 866-810-8976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number21057
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: