Provider Demographics
NPI:1154424000
Name:HYLER-BOTH, DAVID (D O)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:HYLER-BOTH
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1049
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-4049
Mailing Address - Country:US
Mailing Address - Phone:304-645-4043
Mailing Address - Fax:304-645-4713
Practice Address - Street 1:163 GREENBRIER STREET
Practice Address - Street 2:
Practice Address - City:RUPERT
Practice Address - State:WV
Practice Address - Zip Code:25984
Practice Address - Country:US
Practice Address - Phone:304-717-0070
Practice Address - Fax:304-717-0072
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1073204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001371982OtherBC/BS
WV288222OtherONE NET
WV888222OtherOPTIMUM CHOICE
WV4458347OtherAETNA
WV1014329OtherBRICKSTREET
WV288222OtherONE NET