Provider Demographics
NPI:1467504662
Name:SHAMBLIN, DAVID C (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:SHAMBLIN
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 1:2233 S KANAWHA ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-6719
Mailing Address - Country:US
Mailing Address - Phone:304-255-9249
Mailing Address - Fax:304-255-9237
Practice Address - Street 1:2233 S KANAWHA ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6719
Practice Address - Country:US
Practice Address - Phone:304-255-9249
Practice Address - Fax:304-255-9237
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14016207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1335856OtherUMWA
WV0099359000Medicaid
WVSH0577592Medicare PIN
WV1335856OtherUMWA