Provider Demographics
NPI:1154489235
Name:OFIR, EREZ A (MD)
Entity Type:Individual
Prefix:MR
First Name:EREZ
Middle Name:A
Last Name:OFIR
Suffix:
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:PO BOX 1143
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-1143
Mailing Address - Country:US
Mailing Address - Phone:304-487-3559
Mailing Address - Fax:304-487-7928
Practice Address - Street 1:109 MORRISON DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2322
Practice Address - Country:US
Practice Address - Phone:304-487-3559
Practice Address - Fax:304-487-7928
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16197207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0059862000Medicaid
F37703Medicare UPIN
0724801Medicare ID - Type Unspecified