Provider Demographics
NPI:1205857257
Name:STILL, BRIAN L (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:STILL
Suffix:
Gender:M
Credentials:DO
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 228
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-0228
Mailing Address - Country:US
Mailing Address - Phone:740-380-4181
Mailing Address - Fax:740-380-2734
Practice Address - Street 1:1383 W HUNTER ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-1013
Practice Address - Country:US
Practice Address - Phone:740-385-0202
Practice Address - Fax:740-380-2734
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004839208M00000X
OH34-00-4839207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810023715Medicaid
OHH100891Medicaid
OH0836386Medicaid
OHST0867933Medicare PIN