Healthcare Provider Details

I. General information

NPI: 1043223175
Provider Name (Legal Business Name): JON L VOGLER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 WATER ST WELLSBORO LAUREL HEALTH CENTER
WELLSBORO PA
16901-1126
US

IV. Provider business mailing address

22 WALNUT ST LAUREL HEALTH CENTER ADMINISTRATION
WELLSBORO PA
16901-1526
US

V. Phone/Fax

Practice location:
  • Phone: 570-724-1010
  • Fax: 570-724-3970
Mailing address:
  • Phone: 570-723-0500
  • Fax: 570-724-1197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA000287L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: