Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DS020417L | PA |
Y | 213EG0000X | General Practice | DS020417L | PA |
NPI | 1003065285 |
---|---|
Provider Name | Dr. Jan Brown |
First Address | Hastings, PA 16646-5510 |
Second Address | Hastings, PA 16646-5510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2008 |
Last Update Date | 12/09/2008 |