Provider Demographics
NPI:1336234921
Name:BEZ, EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:BEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-4929
Mailing Address - Country:US
Mailing Address - Phone:304-256-7100
Mailing Address - Fax:304-256-7111
Practice Address - Street 1:101 S EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4929
Practice Address - Country:US
Practice Address - Phone:304-256-7100
Practice Address - Fax:304-256-7111
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB599372084P0800X
WV26822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ618530Medicaid
WV3810025732Medicaid
AZAZ0771690OtherBCBS
WV3810025732Medicaid
F74987Medicare UPIN
AZAZ0771690OtherBCBS