Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD023880E | PA |
NPI | 1003818204 |
---|---|
Provider Name | Mitchell F Shmokler |
First Address | Broomall, PA 19008-4202 |
Second Address | Havertown, PA 19083-4530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 16/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0008557550001 | (05) | PA |
080084180 | RAILROAD MEDICARE (01) |