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General NPI Number Information
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NPI Number | 1467524082
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Entity Type | Organization
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Legal Business Name | GREENBRIER VALLEY ENT PLLC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 118 TAYLOR LN
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City | RONCEVERTE
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State | WV
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Zip | 24970-1337
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Country | US
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Telephone | 304-520-4991
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 902
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City | LEWISBURG
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State | WV
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Zip | 24901-0902
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Country | US
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Telephone | 304-520-4991
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Fax |
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | MR. CHRISTOPHER LEE WHITE
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Credential | D.O.
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Telephone | 304-645-0870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number |
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License Number State |
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