Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | MD456308 | PA |
NPI | 1093997280 |
---|---|
Provider Name | Dr. Paul Jerome Palafox Custodio |
First Address | New Kensington, PA 15068-6071 |
Second Address | New Kensington, PA 15068-6071 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2007 |
Last Update Date | 08/10/2020 |