Wuebbolt, Gordon Edgar
Wuebbolt, Gordon Edgar is an sole proprietor health care provider with primary practice located at 2 Farm Colony Drive , Warren PA 16365-5206. He recently has 3 registered licenses in different health care specialties including Eye and Vision Services Providers / Ophthalmic, Allopathic & Osteopathic Physicians / Ophthalmology, Allopathic & Osteopathic Physicians / Ophthalmic Plastic and Reconstructive Surgery. Allopathic & Osteopathic Physicians / Ophthalmology is his primary health care specialty. Wuebbolt, Gordon Edgar can be contacted via phone (814) 726-2303.Contact Information
Primary practice address
2 Farm Colony Drive
Warren PA 16365-5206
Phone: (814) 726-2303
Fax: (814) 726-7459
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Ophthalmic | 156FX1100X | MD052930L | Pennsylvania |
| Eye and Vision Services Providers / Ophthalmic | 156FX1100X | 219642-1 | New York |
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | 219642-1 | New York |
| Allopathic & Osteopathic Physicians / Ophthalmic Plastic and Reconstructive Surgery | 207WX0200X | 219642-1 | New York |
| Allopathic & Osteopathic Physicians / Ophthalmic Plastic and Reconstructive Surgery | 207WX0200X | MD052930L | Pennsylvania |
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | MD052930L | Pennsylvania |
Profile Details
| NPI number | 1548234255 |
|---|---|
| LBN Legal business name | Wuebbolt, Gordon Edgar |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 17th, 2006 |
| Last updated | Oct 13th, 2021 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1548234255 | NPPES |
| Pennsylvania | MEDICAID | 001464588 | |
| Pennsylvania | MEDICAID | 02155728 |
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