Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS009430L | PA |
NPI | 1003802760 |
---|---|
Provider Name | Jeffery Jude Dunkelberger |
First Address | Middleburg, PA 17842-8910 |
Second Address | Enola, PA 17025-2354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 22/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
043825F6K | MEDICARE PTAN (01) | PA |
1028233600001 | (05) | PA |