Individual
JOEDY L DARISTOTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1712 LOCUST AVE, FAIRMONT, WV 26554-1321
(304) 366-6157
(304) 366-0177
Mailing address
1712 LOCUST AVE, FAIRMONT, WV 26554-1321
(304) 366-6157
(304) 366-0177
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
PT21491
ND
207YX0602X
Otolaryngic Allergy Physician
Primary
WV14772
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0041418000
—
WV
Enumeration date
03/01/2007
Last updated
09/23/2024
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