Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MD044166E | PA |
NPI | 1013954890 |
---|---|
Provider Name | John Whyte |
First Address | Elkins Park, PA 19027-2220 |
Second Address | Philadelphia, PA 19120-2421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H58036 | (02) | PA |