Provider Demographics
NPI:1679547533
Name:HIVELY, JEFFREY WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WAYNE
Last Name:HIVELY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:380 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOYDTON
Mailing Address - State:VA
Mailing Address - Zip Code:23917-3415
Mailing Address - Country:US
Mailing Address - Phone:434-738-6420
Mailing Address - Fax:434-791-4126
Practice Address - Street 1:705 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1803
Practice Address - Country:US
Practice Address - Phone:434-791-4122
Practice Address - Fax:434-791-4126
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2024-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101247969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVF84465Medicare UPIN