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General NPI Number Information
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NPI Number | 1639706591
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Entity Type | Individual
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Provider Name | BRYCE ELWIN ANDERSON
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Gender | Male
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Dates
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Enumeration Date | 03/23/2020
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 800 WHEELING AVE
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City | GLEN DALE
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State | WV
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Zip | 26038-1697
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Country | US
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Telephone | 48-453-2113
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Fax | 304-843-3202
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Provider Business Mailing Address
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Address Line | PO BOX 9149
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City | MORGANTOWN
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State | WV
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Zip | 26506-9149
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Country | US
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Telephone | 304-293-2436
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Fax | 304-293-6702
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | M-17103
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 31944
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License Number State | WV
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