Healthcare Provider Details

I. General information

NPI: 1306807524
Provider Name (Legal Business Name): ROBERT G GIVEN JR. PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MED CENTER DR LOUIS A. JOHNSON VA MEDICAL CENTER
CLARKSBURG WV
26301-4155
US

IV. Provider business mailing address

1 MED CENTER DR LOUIS A. JOHNSON VA MEDICAL CENTER
CLARKSBURG WV
26301-4155
US

V. Phone/Fax

Practice location:
  • Phone: 304-623-3461
  • Fax: 304-626-7724
Mailing address:
  • Phone: 304-623-3461
  • Fax: 304-626-7724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: