Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 71101 | GA |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | OS17743 | PA |
NPI | 1508008665 |
---|---|
Provider Name | Jacob Matthew Budny |
First Address | Johnstown, PA 15905-2832 |
Second Address | Johnstown, PA 15905-2832 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2009 |
Last Update Date | 24/08/2015 |