Individual
DR. ETHAN B COLLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
122 12TH ST, PRINCETON, WV 24740-2312
(304) 425-7127
(304) 487-7235
Mailing address
122 12TH ST, PRINCETON, WV 24740-2312
(304) 425-7127
(304) 487-7235
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
0102202357
VA
208100000X
Physical Medicine & Rehabilitation Physician
Primary
4641
WV
Other
Enumeration date
10/24/2007
Last updated
10/17/2025
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