Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DS017813-L | PA |
NPI | 1144360439 |
---|---|
Provider Name | Dr. William J Rieger |
First Address | Philadelphia, PA 19129-1302 |
Second Address | Philadelphia, PA 19140-5007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 17/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0061250000 | GROUP PROVIDER NUMBER (01) | PA |
T29767 | (02) | PA |