Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | OS018868 | PA |
N | 111NI0900X | Internist | OS018868 | PA |
N | 207R00000X | Internist | OT015060 | PA |
N | 111NI0900X | Internist | OT015060 | PA |
Y | 207RC0200X | Critical Care Medicine | OS018868 | PA |
NPI | 1033452883 |
---|---|
Provider Name | Dr. John Joseph Sobuto III |
First Address | Danville, PA 17822-4903 |
Second Address | Scranton, PA 18510-2369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2013 |
Last Update Date | 27/08/2020 |