Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | 011287 | NY |
Y | 111NN0400X | Neurology | DC009912 | PA |
NPI | 1376745927 |
---|---|
Provider Name | Dr. John Paul Boustead |
First Address | Pittsburgh, PA 15203-1707 |
Second Address | Pittsburgh, PA 15203-1707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 12/02/2008 |