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
206 SKYLAR DR, LEWISBURG, WV 24901-9383
(681) 318-3540
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
0101263258
VA
207Y00000X
Otolaryngology Physician
Primary
23770
WV
207Y00000X
Otolaryngology Physician
55925
KY
Other
Enumeration date
03/25/2008
Last updated
01/07/2022
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