Provider Demographics
NPI:1164529889
Name:ASBURY, DONALD WALTER (MD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:WALTER
Last Name:ASBURY
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 1:1240 HOCKMAN PIKE
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605
Mailing Address - Country:US
Mailing Address - Phone:276-322-2278
Mailing Address - Fax:276-322-3650
Practice Address - Street 1:1240 HOCKMAN PIKE
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605
Practice Address - Country:US
Practice Address - Phone:276-322-2278
Practice Address - Fax:276-322-3650
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101050993207K00000X, 207R00000X
WV17847207K00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0070397000OtherMEDICAID
VA005855331Medicaid
VA005855331Medicaid
F63440Medicare UPIN