=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427158484
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOEL DAVID SHIFFLER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2003 MURDOCK STE A
-----------------------------------------------------
City | PARKERSBURG
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-422-3999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4370
-----------------------------------------------------
City | PARKERSBURG
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-422-3999
-----------------------------------------------------
Fax | 304-422-1454
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 20094WV
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------