Provider Demographics
NPI:1164418737
Name:EILERS, JOHN W (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:EILERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:W
Other - Last Name:EILERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:HC 69N BOX 23
Mailing Address - Street 2:
Mailing Address - City:SLATYFORK
Mailing Address - State:WV
Mailing Address - Zip Code:26291-9506
Mailing Address - Country:US
Mailing Address - Phone:304-572-4410
Mailing Address - Fax:304-572-4420
Practice Address - Street 1:HC 69N BOX 23
Practice Address - Street 2:
Practice Address - City:SLATYFORK
Practice Address - State:WV
Practice Address - Zip Code:26291-9506
Practice Address - Country:US
Practice Address - Phone:304-572-4410
Practice Address - Fax:304-572-4420
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0053742000Medicaid
WV0742654Medicare PIN
WVF62904Medicare UPIN