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General NPI Number Information
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NPI Number | 1508489246
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Entity Type | Individual
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Provider Name | ZACKERY ERIC ASBURY MD
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Gender | Male
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 600 E MCDONALD AVE
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City | MAN
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State | WV
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Zip | 25635-1023
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Country | US
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Telephone | 304-583-8585
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Fax | 304-583-0129
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Provider Business Mailing Address
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Address Line | PO BOX 114
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City | DAVIN
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State | WV
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Zip | 25617-0114
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Country | US
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Telephone | 304-942-7633
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 31508
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License Number State | WV
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