Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DS015819L | PA |
Y | 213EG0000X | General Practice | DS015819L | PA |
NPI | 1003003054 |
---|---|
Provider Name | John F Wyble |
First Address | Monroeville, PA 15146 |
Second Address | Monroeville, PA 15146 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2007 |
Last Update Date | 01/03/2012 |