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Individual

DERRICK JEROME SHOWALTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1122 MERCER ST, PRINCETON, WV 24740-3030
(304) 800-0544
Mailing address
1122 MERCER ST, PRINCETON, WV 24740-3030
(304) 800-0544

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
F341538
WV

Other

Enumeration date
05/28/2021
Last updated
05/28/2021
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Product
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