Healthcare Provider Details

I. General information

NPI: 1760479133
Provider Name (Legal Business Name): WILLIAM DOUGLAS GIVEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOYLMAN DRIVE
GASSAWAY WV
26624-1137
US

IV. Provider business mailing address

617 RIVER ST
GASSAWAY WV
26624-1137
US

V. Phone/Fax

Practice location:
  • Phone: 304-364-5156
  • Fax: 304-364-1188
Mailing address:
  • Phone: 304-364-8941
  • Fax: 304-364-8943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number13986
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13986
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: