Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MT205953 | PA |
NPI | 1003234378 |
---|---|
Provider Name | John Bernett |
First Address | Danville, PA 17822-9800 |
Second Address | Danville, PA 17822-9800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2014 |
Last Update Date | 07/07/2015 |