Healthcare Provider Details

I. General information

NPI: 1184648297
Provider Name (Legal Business Name): DAVID RUSSELL AYERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HARBOUR WAY
MILTON WV
25541-1545
US

IV. Provider business mailing address

PO BOX 39
MILTON WV
25541-0039
US

V. Phone/Fax

Practice location:
  • Phone: 304-743-1407
  • Fax: 304-743-4516
Mailing address:
  • Phone: 304-743-1407
  • Fax: 304-743-4516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14758
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: