Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD418345 | PA |
NPI | 1033178389 |
---|---|
Provider Name | Dr. Dale C. Kephart |
First Address | Danville, PA 17822-3034 |
Second Address | Lewistown, PA 17044-3400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B67181 | (02) |