Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MD420588 | PA |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | MD420588 | PA |
NPI | 1285698811 |
---|---|
Provider Name | John T Repke |
First Address | Hershey, PA 17033-0854 |
Second Address | Hershey, PA 17033-2360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 18/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0019194540001 | (05) | PA |
E42041 | (02) |