Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | MD028407L | PA |
NPI | 1487767570 |
---|---|
Provider Name | Dr. Jose Horacio Auday |
First Address | Bala Cynwyd, PA 19004-1516 |
Second Address | Bala Cynwyd, PA 19004-1516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D68487 | (02) | PA |