Provider Demographics
NPI:1255704946
Name:DOUG EITEL MD, PLLC
Entity type:Organization
Organization Name:DOUG EITEL MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:EITEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-776-0933
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:ALDERSON
Mailing Address - State:WV
Mailing Address - Zip Code:24910-0147
Mailing Address - Country:US
Mailing Address - Phone:719-776-0933
Mailing Address - Fax:866-810-8976
Practice Address - Street 1:206 SKYLAR DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9383
Practice Address - Country:US
Practice Address - Phone:719-776-0933
Practice Address - Fax:866-810-8976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV210572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty