Individual
DR. JUSTIN WAYNE DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1256 N EISENHOWER DR, BECKLEY, WV 25801-3120
(304) 254-2641
Mailing address
1256 N EISENHOWER DR, BECKLEY, WV 25801-3120
(304) 254-2820
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
0101263258
VA
207Y00000X
Otolaryngology Physician
Primary
23770
WV
207Y00000X
Otolaryngology Physician
55925
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100790080
—
KY
Enumeration date
03/25/2008
Last updated
08/04/2026
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