Healthcare Provider Details

I. General information

NPI: 1285806380
Provider Name (Legal Business Name): HENRY NGOE MOKUBE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 HECKEL RD SUITE 206
MC KEES ROCKS PA
15136-1616
US

IV. Provider business mailing address

27 HECKEL RD SUITE 206
MC KEES ROCKS PA
15136-1616
US

V. Phone/Fax

Practice location:
  • Phone: 412-777-4332
  • Fax: 412-777-4310
Mailing address:
  • Phone: 412-777-4332
  • Fax: 412-777-4310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA053237
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: