Provider Demographics
NPI:1073517983
Name:GOETZ, DAVID WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAM
Last Name:GOETZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 AVERY OLIVIA WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-9375
Mailing Address - Country:US
Mailing Address - Phone:304-363-7000
Mailing Address - Fax:304-366-7413
Practice Address - Street 1:1063 MAPLE DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2848
Practice Address - Country:US
Practice Address - Phone:304-598-2992
Practice Address - Fax:304-598-5901
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WVNA207K00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0070421000Medicaid
WVH39825Medicare UPIN
4239411Medicare PIN