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General NPI Number Information
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NPI Number | 1467630079
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Entity Type | Organization
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Legal Business Name | WAHL & SON'S FAMILY PRACTICE, P.C.
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 835 EDMUND ST
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City | HARMONY
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State | PA
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Zip | 16037-9109
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Country | US
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Telephone | 724-452-7370
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Fax | 724-452-8599
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Provider Business Mailing Address
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Address Line | 835 EDMUND ST
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City | HARMONY
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State | PA
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Zip | 16037-9109
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Country | US
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Telephone | 724-452-7370
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Fax | 724-452-8599
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. JEFFRY ROSS WAHL
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Credential | M.D.
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Telephone | 724-452-7370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD040649L
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License Number State | PA
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