Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | MD068102L | PA |
NPI | 1003868498 |
---|---|
Provider Name | Glenn Shopper |
First Address | Philadelphia, PA 19141-3018 |
Second Address | Philadelphia, PA 19120-2421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F26448 | (02) | PA |