Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | MD023792E | PA |
NPI | 1659580348 |
---|---|
Provider Name | John Taylor Symons |
First Address | Williamsburg, PA 16693 |
Second Address | Williamsburg, PA 16693 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 02/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
106082 | (05) | PA |
B70966 | (02) | PA |