Individual
MR. BILLY J BRAGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
215 W MAIN ST, BRIDGEPORT, WV 26330-1748
(304) 842-6645
(304) 842-4909
Mailing address
RR 1 BOX 359A, MOUNT CLARE, WV 26408-9731
(304) 622-6646
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
000554
WV
Other
Enumeration date
01/26/2007
Last updated
05/07/2008
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