Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | OS012787 | PA |
NPI | 1205871696 |
---|---|
Provider Name | Jeanne Doperak |
First Address | Monroeville, PA 15146-2338 |
Second Address | Monroeville, PA 15146-2355 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 25/03/2021 |