Organization
GREENBRIER VALLEY UROLOGY ASSOCIATES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE F FORT (MD PRESIDENT)
(304) 647-5642
Entity
Organization
Contact information
Practice address
119 MAPLEWOOD AVE, RONCEVERTE, WV 24970-9737
(304) 647-5642
(304) 647-5644
Mailing address
119 MAPLEWOOD AVE, RONCEVERTE, WV 24970-9737
(304) 647-5642
(304) 647-5644
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Enumeration date
09/23/2005
Last updated
02/11/2014
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