Provider Demographics
NPI:1770627028
Name:SCHREIBER, RUSSELL LOUIS (DO)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:LOUIS
Last Name:SCHREIBER
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 1:501 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26187-1615
Mailing Address - Country:US
Mailing Address - Phone:304-375-7992
Mailing Address - Fax:304-375-3762
Practice Address - Street 1:501 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:WV
Practice Address - Zip Code:26187-1615
Practice Address - Country:US
Practice Address - Phone:304-375-7992
Practice Address - Fax:304-375-3762
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV676207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0049300000Medicaid
WVD93767Medicare UPIN
WV0049300000Medicaid