Provider Demographics
NPI:1194867952
Name:W. ERIC SHRADER MD PC
Entity Type:Organization
Organization Name:W. ERIC SHRADER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:W
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:SHRADER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-979-1323
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24651-0309
Mailing Address - Country:US
Mailing Address - Phone:276-979-1323
Mailing Address - Fax:276-979-9123
Practice Address - Street 1:986 BEN BOLT AVE
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651
Practice Address - Country:US
Practice Address - Phone:276-979-1323
Practice Address - Fax:276-979-9123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037561207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty