Healthcare Provider Details

I. General information

NPI: 1396752861
Provider Name (Legal Business Name): WILLIAM REEVES MINOR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5861 MASON DIXON HWY
BLACKSVILLE WV
26521
US

IV. Provider business mailing address

PO BOX 72
BLACKSVILLE WV
26521-0072
US

V. Phone/Fax

Practice location:
  • Phone: 304-432-8211
  • Fax: 304-432-8213
Mailing address:
  • Phone: 304-432-8211
  • Fax: 304-432-8213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number729
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS006467E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: