Provider Demographics
NPI:1184648297
Name:AYERS, DAVID RUSSELL (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RUSSELL
Last Name:AYERS
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 39
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WV
Mailing Address - Zip Code:25541-0039
Mailing Address - Country:US
Mailing Address - Phone:304-743-1407
Mailing Address - Fax:304-743-4516
Practice Address - Street 1:1 HARBOUR WAY
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WV
Practice Address - Zip Code:25541-1545
Practice Address - Country:US
Practice Address - Phone:304-743-1407
Practice Address - Fax:304-743-4516
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14758207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0052275000Medicaid
WVB42732Medicare UPIN
WV0052275000Medicaid