Provider Demographics
NPI:1386682532
Name:GUILFOOSE, JOHN ALAN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALAN
Last Name:GUILFOOSE
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:RR 1 BOX 171
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:WV
Mailing Address - Zip Code:26440-9622
Mailing Address - Country:US
Mailing Address - Phone:304-265-6963
Mailing Address - Fax:304-265-6961
Practice Address - Street 1:301 S PRICE ST
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-1484
Practice Address - Country:US
Practice Address - Phone:304-329-6963
Practice Address - Fax:304-329-6961
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22052207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004186Medicaid
WVI46819Medicare UPIN
WVGU4174641Medicare ID - Type Unspecified