Provider Demographics
NPI:1255546750
Name:WILLIAM A SANPABLO
Entity type:Organization
Organization Name:WILLIAM A SANPABLO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAN PABLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-457-1306
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:PHILIPPI
Mailing Address - State:WV
Mailing Address - Zip Code:26416-0070
Mailing Address - Country:US
Mailing Address - Phone:304-457-1306
Mailing Address - Fax:304-457-1307
Practice Address - Street 1:2 HEALTH CARE DRIVE
Practice Address - Street 2:
Practice Address - City:PHILIPPI
Practice Address - State:WV
Practice Address - Zip Code:26416-0070
Practice Address - Country:US
Practice Address - Phone:304-457-1306
Practice Address - Fax:304-457-1307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV11963207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9281882OtherMEDICARE GROUP NUMBER
WV0082862000Medicaid
WV0636044Medicare ID - Type Unspecified
WV9281882OtherMEDICARE GROUP NUMBER