Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | G86283 | CA |
N | 208600000X | Surgeon | G86283 | CA |
Y | 208200000X | Surgeon | MD023951E | PA |
Y | 208600000X | Surgeon | MD023951E | PA |
NPI | 1013918572 |
---|---|
Provider Name | Dr. John Norris Childs III |
First Address | Philadelphia, PA 19144-3715 |
Second Address | Philadelphia, PA 19128-1741 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0730213 | (05) | PA |
C33495 | (02) | PA |