Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD013907E | PA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD013907E | PA |
N | 207V00000X | Obstetrician & Gynecologist | MD013907E | PA |
NPI | 1265451678 |
---|---|
Provider Name | Dr. James S. Studdiford III |
First Address | Philadelphia, PA 19106-3505 |
Second Address | Philadelphia, PA 19107-4405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 21/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001437526 | (05) | PA |
0053562 | (05) | NJ |