Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 733191 | TX |
N | 363LF0000X | Nurse Practitioner - Family Medicine | R219135 | MD |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | SP018994 | PA |
N | 363LP2300X | Nurse Practitioner - Primary Care | 733191 | TX |
NPI | 1033497771 |
---|---|
Provider Name | Joseph D Fagbohun |
First Address | Chambersburg, PA 17201-4232 |
Second Address | Chambersburg, PA 17201-1720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2011 |
Last Update Date | 08/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103518869 | (05) | PA |
3027344 | (05) | TX |