Healthcare Provider Details

I. General information

NPI: 1467524082
Provider Name (Legal Business Name): GREENBRIER VALLEY ENT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 TAYLOR LN
RONCEVERTE WV
24970-1337
US

IV. Provider business mailing address

PO BOX 902
LEWISBURG WV
24901-0902
US

V. Phone/Fax

Practice location:
  • Phone: 304-520-4991
  • Fax:
Mailing address:
  • Phone: 304-520-4991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER LEE WHITE
Title or Position: OWNER PHYSICIAN
Credential: D.O.
Phone: 304-645-0870