Healthcare Provider Details

I. General information

NPI: 1154424000
Provider Name (Legal Business Name): DAVID HYLER-BOTH D. O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 GREENBRIER STREET
RUPERT WV
25984
US

IV. Provider business mailing address

PO BOX 1049
LEWISBURG WV
24901-4049
US

V. Phone/Fax

Practice location:
  • Phone: 304-717-0070
  • Fax: 304-717-0072
Mailing address:
  • Phone: 304-645-4043
  • Fax: 304-645-4713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number1073
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1073
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: