Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CO182275L | PA |
NPI | 1063719334 |
---|---|
Provider Name | Mr. James A. Brown |
First Address | Phila, PA 19120 |
Second Address | Phila, PA 19120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2011 |
Last Update Date | 22/02/2011 |