Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MT209304 | PA |
Y | 207QS0010X | Family Doctor - Sports Medicine | MD466121 | PA |
NPI | 1013396670 |
---|---|
Provider Name | Joshua Augustine Muetzel |
First Address | State College, PA 16801-7965 |
Second Address | Altoona, PA 16602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2015 |
Last Update Date | 17/07/2019 |