Provider Demographics
NPI:1194810929
Name:MINOR FAMILY PRACTICE PLLC
Entity type:Organization
Organization Name:MINOR FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:REEVES
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-285-5515
Mailing Address - Street 1:1401 EARL CORE ROAD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-5839
Mailing Address - Country:US
Mailing Address - Phone:304-285-5515
Mailing Address - Fax:304-285-5524
Practice Address - Street 1:1401 EARL CORE ROAD
Practice Address - Street 2:SUITE D
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-5839
Practice Address - Country:US
Practice Address - Phone:304-285-5515
Practice Address - Fax:304-285-5524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV729207Q00000X
PAOS006467E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty