Provider Demographics
NPI:1851511612
Name:DURWOOD F. GANDEE MD PC
Entity Type:Organization
Organization Name:DURWOOD F. GANDEE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DURWOOD
Authorized Official - Middle Name:F
Authorized Official - Last Name:GANDEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-273-5873
Mailing Address - Street 1:1979 PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:RAVENSWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26164-1378
Mailing Address - Country:US
Mailing Address - Phone:304-273-5873
Mailing Address - Fax:
Practice Address - Street 1:1979 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:RAVENSWOOD
Practice Address - State:WV
Practice Address - Zip Code:26164-1378
Practice Address - Country:US
Practice Address - Phone:304-273-5873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0034612000Medicaid
WV0051029000Medicaid
WVDU9245961Medicare PIN
WV513868Medicare ID - Type Unspecified