Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD421524 | PA |
Y | 207QS0010X | Family Doctor - Sports Medicine | MD421524 | PA |
NPI | 1306874441 |
---|---|
Provider Name | David Webner |
First Address | Springfield, PA 19064-2027 |
Second Address | Springfield, PA 19064-2045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 17/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1010411720003 | (05) | PA |
I05103 | (02) |