Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 25MA04685200 | NJ |
NPI | 1023079522 |
---|---|
Provider Name | Dr. David Joel Medford |
First Address | Morristown, NJ 07960 |
Second Address | Morristown, NJ 07960 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C56941 | (02) |