Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | OS012017 | PA |
N | 208600000X | Surgeon | OS012017 | PA |
N | 2086S0102X | Surgical Critical Care | OS012017 | PA |
Y | 2086S0127X | Trauma Surgeon | 25MB08735500 | NJ |
NPI | 1124184577 |
---|---|
Provider Name | John Chovanes |
First Address | Camden, NJ 08103-1088 |
Second Address | Camden, NJ 08103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 14/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MB08735500 | STATE LICENSE (01) | NJ |