Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | SC002807R | PA |
NPI | 1225035637 |
---|---|
Provider Name | Dr. John Ernest Fawcett |
First Address | Drexel Hill, PA 19026-3814 |
Second Address | Drexel Hill, PA 19026-3814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 04/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T29537 | (02) | PA |