Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175L00000X | Homeopath | MD036890E | PA |
Y | 207R00000X | Internist | MD036890E | PA |
Y | 111NI0900X | Internist | MD036890E | PA |
NPI | 1013915743 |
---|---|
Provider Name | Dr. Henry S Bobeck |
First Address | Kingston, PA 18704-3702 |
Second Address | Sugar Notch, PA 18706-2015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 25/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0010621420001 | (05) | PA |
B41849 | (02) | PA |