Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DS017781L | PA |
Y | 213EG0000X | General Practice | DS017781L | PA |
NPI | 1003937004 |
---|---|
Provider Name | Theodore David Opperman |
First Address | Pen Argyl, PA 18072-9707 |
Second Address | Pen Argyl, PA 18072-9707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 03/08/2011 |