Individual
DR. JOHN R WINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
412 NAMOZINE STREET, BURKEVILLE, VA 23922
(434) 767-4822
(434) 767-2211
Mailing address
PO BOX 927, WHITE SULPHUR SPRINGS, WV 24986-2373
(304) 536-5030
(304) 536-5031
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101029100
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1108312
CIGNA
VA
05
—
1427040112
—
VA
01
—
345648
ANTHEM
VA
01
—
4468872
AETNA
VA
05
—
5633419
—
VA
01
—
61459602
BLACK LUNG/FECA
VA
Enumeration date
08/18/2005
Last updated
10/15/2011
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