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General NPI Number Information
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NPI Number | 1588847487
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Entity Type | Organization
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Legal Business Name | DR. J.L. FUNKHOUSER
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Dates
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Enumeration Date | 12/13/2007
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Last Update Date | 12/13/2007
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Provider Practice Location Address
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Address Line | 721 5TH AVE
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City | NEW BRIGHTON
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State | PA
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Zip | 15066-1836
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Country | US
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Telephone | 724-846-5250
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Fax |
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Provider Business Mailing Address
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Address Line | 721 5TH AVE
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City | NEW BRIGHTON
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State | PA
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Zip | 15066-1836
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Country | US
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Telephone | 724-846-5250
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Fax |
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Authorized Official
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Title or Position | MD
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Name | DR. JAY L FUNKHOUSER
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Credential |
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Telephone | 724-846-5250
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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 | MD028347L
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License Number State | PA
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