Provider Demographics
NPI:1063461895
Name:KYER, PAUL DEAN III (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DEAN
Last Name:KYER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 GREENWAY AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:SO CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309
Mailing Address - Country:US
Mailing Address - Phone:304-766-4444
Mailing Address - Fax:304-766-4447
Practice Address - Street 1:414 GREENWAY AVE
Practice Address - Street 2:STE 100
Practice Address - City:SO CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309
Practice Address - Country:US
Practice Address - Phone:304-766-4444
Practice Address - Fax:304-766-4447
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19792208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5600067000Medicaid
H01225Medicare UPIN
WV5600067000Medicaid