Healthcare Provider Details

I. General information

NPI: 1659580348
Provider Name (Legal Business Name): JOHN TAYLOR SYMONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 06/02/2008

III. Provider practice location address

1 NEW BEGINNINGS ROAD
WILLIAMSBURG PA
16693
US

IV. Provider business mailing address

PO BOX B
WILLIAMSBURG PA
16693
US

V. Phone/Fax

Practice location:
  • Phone: 814-832-2131
  • Fax: 814-832-2133
Mailing address:
  • Phone: 814-832-2131
  • Fax: 814-832-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD023792E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: