Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS018166L | PA |
NPI | 1053359901 |
---|---|
Provider Name | Dr. Fred Robert Sacks |
First Address | Norristown, PA 19401-1610 |
Second Address | Norristown, PA 19401-1610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 08/07/2007 |