Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | MD071551L | PA |
NPI | 1083652051 |
---|---|
Provider Name | Dr. Jonas Joaquin Gopez |
First Address | Willow Grove, PA 19090-1109 |
Second Address | Willow Grove, PA 19090-1109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 02/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1008171110002 | (05) | PA |
BG7099446 | DEA (01) | PA |
H91405 | (02) | PA |