Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | SC-001795-L | PA |
NPI | 1073543559 |
---|---|
Provider Name | Gregory Bancroft |
First Address | Philadelphia, PA 19104-1712 |
Second Address | Philadelphia, PA 19104-1712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 17/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0005005270002 | (05) | PA |