Provider Demographics
NPI:1629659685
Name:SHREVE, CHRISTOPHER SHANE (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:SHANE
Last Name:SHREVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1100 GROSSCUP AVE
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-3120
Mailing Address - Country:US
Mailing Address - Phone:304-768-8811
Mailing Address - Fax:304-768-4072
Practice Address - Street 1:1100 GROSSCUP AVE
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-3120
Practice Address - Country:US
Practice Address - Phone:304-768-8811
Practice Address - Fax:304-768-4072
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV33871207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine