Healthcare Provider Details

I. General information

NPI: 1750645560
Provider Name (Legal Business Name): JOEL DOUGLAS HIMES D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 HOSPITAL AVE STE 311
DU BOIS PA
15801-1465
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-375-6200
  • Fax: 814-375-6452
Mailing address:
  • Phone: 814-371-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS017442
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberOS017442
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: