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DR. JOHN R WINE

>> Family Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1427040112

Individual Registrant:
DR. JOHN R WINE 
Gender: M
Not Sole Proprietor

Location and contact information for practice:
412 NAMOZINE STREET  BURKEVILLE, VA 23922 US
Tel: 434-767-4822  Fax: 434-767-2211

Contact information for business:
PO BOX 927  WHITE SULPHUR SPRINGS, WV 24986-2373 US
Tel: 304-536-5030  Fax: 304-536-5031

Registration Information:
NPI: 1427040112
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207Q00000XAllopathic & Osteopathic Physicians
Family Medicine
VA0101029100

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
AETNA4468872VA01
CIGNA1108312VA01
1427040112VA05
BLACK LUNG/FECA61459602VA01
5633419VA05
ANTHEM345648VA01




HEALTH CARE JOBS VA - Page 1



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