Individual
ERNESTO MANUEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
396 DINGESS ST, LOGAN, WV 25601-3624
(304) 831-1700
(304) 831-1726
Mailing address
396 DINGESS ST, LOGAN, WV 25601-3624
(304) 831-1700
(304) 831-1726
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14503
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0057545000
—
WV
Enumeration date
04/17/2006
Last updated
03/18/2014
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