Provider Demographics
NPI:1164969481
Name:MCBRAYER, LIONEL DWAYNE II
Entity Type:Individual
Prefix:MR
First Name:LIONEL
Middle Name:DWAYNE
Last Name:MCBRAYER
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 FRAZIER WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-9018
Mailing Address - Country:US
Mailing Address - Phone:304-541-1000
Mailing Address - Fax:
Practice Address - Street 1:14 FRAZIER WAY
Practice Address - Street 2:
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560-9018
Practice Address - Country:US
Practice Address - Phone:304-541-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer