Provider Demographics
NPI:1760479133
Name:GIVEN, WILLIAM DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DOUGLAS
Last Name:GIVEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:617 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:GASSAWAY
Mailing Address - State:WV
Mailing Address - Zip Code:26624-1137
Mailing Address - Country:US
Mailing Address - Phone:304-364-8941
Mailing Address - Fax:304-364-8943
Practice Address - Street 1:100 HOYLMAN DRIVE
Practice Address - Street 2:
Practice Address - City:GASSAWAY
Practice Address - State:WV
Practice Address - Zip Code:26624-1137
Practice Address - Country:US
Practice Address - Phone:304-364-5156
Practice Address - Fax:304-364-1188
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13986208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00658278OtherRR MEDICARE
WV0057134000Medicaid
WV0057134000Medicaid
WVE65794Medicare UPIN
WVGI0586001Medicare PIN
WV2030945Medicare PIN