Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | MD-034945-L | PA |
NPI | 1750425351 |
---|---|
Provider Name | Dr. Joao O Tavares |
First Address | Philadelphia, PA 19178-7642 |
Second Address | Erie, PA 16505-5097 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 27/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0662516-02 | (05) | PA |
B96763 | (02) | PA |