Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 22DI01270800 | NJ |
NPI | 1033102777 |
---|---|
Provider Name | Dr. Donald Glenn Rebhun |
First Address | Voorhees, NJ 08043-4501 |
Second Address | Voorhees, NJ 08043-4501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U24764 | (02) |