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NPI Code Detail

MEDICARE: MR. DAVID A GANT PA-C

MEDICARE: MR. DAVID A GANT PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant0711WV

General Provider Information

NPI Number : 1386623288
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID A GANT PA-C
Provider Business Mailing Address
First Line : 1200 J D ANDERSON DR
Second Line :
City : MORGANTOWN
State : WV
Zip : 26505-3494
Country : US
Telephone Number : 304-598-1996
Fax Number : 304-285-2107
Provider Business Practice Location Address
First Line : 1200 J D ANDERSON DR
Second Line :
City : MORGANTOWN
State : WV
Zip : 26505-3494
Country : US
Telephone Number : 304-598-1996
Fax Number : 304-285-2107
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2006
Last Update Date : 12/14/2018

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Directions to “ MR. DAVID A GANT PA-C” Practice Location

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