Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | OS021706 | PA |
N | 208000000X | Pediatrician | Q5064 | TX |
Y | 2084N0402X | Child Neurologist | OS021706 | PA |
N | 2084N0402X | Child Neurologist | Q5064 | TX |
NPI | 1316380249 |
---|---|
Provider Name | Dr. Dustin Jacob Paul |
First Address | Hershey, PA 17033-2360 |
Second Address | Hershey, PA 17033-2008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2013 |
Last Update Date | 21/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3978711701 | (05) | TX |
H08LF29301 | BCBS (01) | TX |