Individual
GAYLAND OLIVER HETHCOAT
Active
Individual
GAYLAND OLIVER HETHCOAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101231968
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000875693
WV BLUE SHIELD
—
01
—
001717444
WV BLUE SHIELD
—
05
—
005873959
—
VA
05
—
2001954000
—
WV
01
—
2119638
MAMSI PROFESSIONAL
—
01
—
219651
ANTHEM PROFESSIONAL
—
01
—
3810003817
WV MEDICAID GROUP
WV
01
—
53556
SENTARA PROFESSIONAL
—
01
—
C00085
VA MEDICARE B
—
Enumeration date
04/06/2006
Last updated
03/03/2021
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