Provider Demographics
NPI:1043223175
Name:VOGLER, JON L (PA-C)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:L
Last Name:VOGLER
Suffix:
Gender:M
Credentials:PA-C
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Other - Last Name:
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Mailing Address - Street 1:22 WALNUT ST
Mailing Address - Street 2:LAUREL HEALTH CENTER ADMINISTRATION
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1526
Mailing Address - Country:US
Mailing Address - Phone:570-723-0500
Mailing Address - Fax:570-724-1197
Practice Address - Street 1:7 WATER ST
Practice Address - Street 2:WELLSBORO LAUREL HEALTH CENTER
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1126
Practice Address - Country:US
Practice Address - Phone:570-724-1010
Practice Address - Fax:570-724-3970
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2015-09-01
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Provider Licenses
StateLicense IDTaxonomies
PAMA000287L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R97193Medicare UPIN
086388FEMMedicare ID - Type Unspecified