Provider Demographics
NPI:1922686641
Name:AGENOR, AOUOD (MD)
Entity Type:Individual
Prefix:
First Name:AOUOD
Middle Name:
Last Name:AGENOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1448 10TH AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3579
Mailing Address - Country:US
Mailing Address - Phone:304-691-1262
Mailing Address - Fax:304-691-1666
Practice Address - Street 1:1600 MEDICAL CENTER DR STE G500
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3659
Practice Address - Country:US
Practice Address - Phone:304-691-1262
Practice Address - Fax:304-691-1666
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV32295207XX0005X, 207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery