Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | DS014362L | PA |
NPI | 1023044922 |
---|---|
Provider Name | Sherman Spatz |
First Address | Washington, PA 15301 |
Second Address | Washington, PA 15301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 10/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0005215630006 | (05) | PA |
T71633 | (02) |