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General NPI Number Information
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NPI Number | 1578985545
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Entity Type | Individual
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Provider Name | DAVID PAULK
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Gender | Male
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Dates
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Enumeration Date | 01/10/2014
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Last Update Date | 01/10/2014
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Provider Practice Location Address
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Address Line | 318 PROSPECT ST
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City | STAUNTON
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State | VA
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Zip | 24401-3605
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Country | US
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Telephone | 540-887-4055
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1500
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City | STAUNTON
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State | VA
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Zip | 24402-1500
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Country | US
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Telephone | 540-887-4055
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0770840322
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License Number State | VA
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