1205833258 NPI number — DR. BRYAN D RAYBUCK M.D.

Table of content: DR. BRYAN D RAYBUCK M.D. (NPI 1205833258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205833258 NPI number — DR. BRYAN D RAYBUCK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAYBUCK
Provider First Name:
BRYAN
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205833258
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGANTOWN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26506-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-598-4800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-598-4800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  0101043192 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 27250 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 27250 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 541042964 . This is a "ONE HEALTH PLAN/GREAT WST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 006042031 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 541042964 . This is a "HEALTHNET/TRICARE/CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060007366 . This is a "MEDICARE - RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541042964 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4137746 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6975-0007 . This is a "CAREFIRST BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 502860 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541042964 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 054847 . This is a "ANTHEM BCBS/TRIGON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 486305 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541042964 . This is a "CIGNO PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541042964 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".