Healthcare Provider Details

I. General information

NPI: 1205092509
Provider Name (Legal Business Name): GERARD J OAKLEY III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 10TH AVENUE
HUNTINGTON WV
25701
US

IV. Provider business mailing address

1001 10TH AVENUE
HUNTINGTON WV
25701
US

V. Phone/Fax

Practice location:
  • Phone: 304-697-4497
  • Fax: 304-523-9470
Mailing address:
  • Phone: 304-697-4497
  • Fax: 304-523-9470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number24513
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License Number24513
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: