Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | MD457096 | PA |
NPI | 1114160173 |
---|---|
Provider Name | Mr. Luiz Goncalves Foernges |
First Address | Danville, PA 17822-9800 |
Second Address | Danville, PA 17822-9800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2009 |
Last Update Date | 05/08/2020 |