Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | SC003897L | PA |
NPI | 1053337931 |
---|---|
Provider Name | Mr. Jeffrey George Rieder |
First Address | Peckville, PA 18452-2043 |
Second Address | Peckville, PA 18452-2043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U48244 | (02) | PA |