Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS019847L | PA |
NPI | 1114904331 |
---|---|
Provider Name | Dr. J Victor Ehrens |
First Address | Allentown, PA 18103-6205 |
Second Address | Allentown, PA 18103-6205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 22/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0003889 | AETNA (01) | PA |
157951 | HIGHMARK BS # (01) | PA |
50047080 | CAPITAL BLUE CROSS # (01) | PA |