Healthcare Provider Details

I. General information

NPI: 1063461895
Provider Name (Legal Business Name): PAUL DEAN KYER III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 GREENWAY AVE STE 100
SO CHARLESTON WV
25309
US

IV. Provider business mailing address

414 GREENWAY AVE STE 100
SO CHARLESTON WV
25309
US

V. Phone/Fax

Practice location:
  • Phone: 304-766-4444
  • Fax: 304-766-4447
Mailing address:
  • Phone: 304-766-4444
  • Fax: 304-766-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number19792
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: