Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | SC003138L | PA |
NPI | 1033141379 |
---|---|
Provider Name | Dr. David Potash |
First Address | Wilkes Barre, PA 18701-3301 |
Second Address | Wilkes Barre, PA 18701-3301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 30/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012022340002 | (05) | PA |