Provider Demographics
NPI:1518286921
Name:MYNES, CHESTER FRANKLIN JR (DO)
Entity Type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:FRANKLIN
Last Name:MYNES
Suffix:JR
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:BOX 322 HENSON ROAD
Mailing Address - Street 2:RR 12
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9308
Mailing Address - Country:US
Mailing Address - Phone:304-562-2566
Mailing Address - Fax:
Practice Address - Street 1:RR 12
Practice Address - Street 2:322 HENSON ROAD
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9308
Practice Address - Country:US
Practice Address - Phone:304-562-2566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0477207Q00000X
KY1090207Q00000X
OH1511207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64010903Medicaid
OH0402808Medicaid
KY1032001Medicare Oscar/Certification
KYE01345Medicare UPIN
KY1032001Medicare PIN