=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437151677
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN L BEHM M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2005
-----------------------------------------------------
Last Update Date | 08/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2480 MATTERHORN DR
-----------------------------------------------------
City | WEXFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15090-7612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-862-6778
-----------------------------------------------------
Fax | 888-841-8567
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2480 MATTERHORN DR
-----------------------------------------------------
City | WEXFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15090-7612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-862-6778
-----------------------------------------------------
Fax | 888-841-8567
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD060134-L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------