Provider Demographics
NPI:1942289988
Name:EGNOR, JAMES KESLEY II (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:KESLEY
Last Name:EGNOR
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1004
Mailing Address - Street 2:BARRON DR
Mailing Address - City:INSTITUTE
Mailing Address - State:WV
Mailing Address - Zip Code:25112-1004
Mailing Address - Country:US
Mailing Address - Phone:304-766-4855
Mailing Address - Fax:304-766-4954
Practice Address - Street 1:BARRON DR
Practice Address - Street 2:
Practice Address - City:INSTITUTE
Practice Address - State:WV
Practice Address - Zip Code:25112-1004
Practice Address - Country:US
Practice Address - Phone:304-766-4855
Practice Address - Fax:304-766-4954
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
WV09377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0073892000Medicaid
WV09377OtherWV BD OF MEDICINE
WV09377OtherWV BD OF MEDICINE
WVF25633Medicare UPIN