Healthcare Provider Details

I. General information

NPI: 1508489246
Provider Name (Legal Business Name): ZACKERY ERIC ASBURY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E MCDONALD AVE
MAN WV
25635-1023
US

IV. Provider business mailing address

PO BOX 114
DAVIN WV
25617-0114
US

V. Phone/Fax

Practice location:
  • Phone: 304-583-8585
  • Fax: 304-583-0129
Mailing address:
  • Phone: 304-942-7633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31508
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: