Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | LT000725 | PA |
NPI | 1073950952 |
---|---|
Provider Name | Jan Goedeke |
First Address | Pittsburgh, PA 15213-2536 |
Second Address | Pittsburgh, PA 15224-1529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2013 |
Last Update Date | 31/05/2013 |