Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 2018004574 | MO |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | MD466938 | PA |
NPI | 1174967715 |
---|---|
Provider Name | Dr. Jeremy John Gebhart |
First Address | Meadville, PA 16335-3719 |
Second Address | Meadville, PA 16335-3719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2013 |
Last Update Date | 10/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103644793 | (05) | PA |