Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | MD041659L | PA |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | MD041659L | PA |
NPI | 1285612010 |
---|---|
Provider Name | Dr. Jeffrey A Buetikofer |
First Address | Erie, PA 16502-4604 |
Second Address | Erie, PA 16502-4604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2006 |
Last Update Date | 29/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012063690007 | (05) | PA |
E02455 | (02) | PA |