Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MSO0262 | ID |
NPI | 1992263438 |
---|---|
Provider Name | Jacob Bryce Thatcher |
First Address | Stratford, NJ 08084-1500 |
Second Address | Stratford, NJ 08084-1500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2019 |
Last Update Date | 04/03/2019 |