Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | MD055731L | PA |
NPI | 1326022575 |
---|---|
Provider Name | Joel J Laury |
First Address | Scranton, PA 18508-2572 |
Second Address | Scranton, PA 18508-2572 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2005 |
Last Update Date | 26/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001536631 | (05) | PA |
F65123 | (02) | PA |