Provider Demographics
NPI:1780663773
Name:JURTA, JOHN PETER (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PETER
Last Name:JURTA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 E GREEN STREET
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-2414
Mailing Address - Country:US
Mailing Address - Phone:570-735-8002
Mailing Address - Fax:570-735-8036
Practice Address - Street 1:33 E GREEN STREET
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-2414
Practice Address - Country:US
Practice Address - Phone:570-735-8002
Practice Address - Fax:570-735-8036
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002862L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0081405OtherBCBS
1079054OtherAETNA
PA10071OtherGEISINGER
PA818743OtherBS 1ST PRIORITY
PA857264OtherAETNA HMO
PA240117OtherAETNA PHS
PA4558691OtherAETNA PPO POS
PA0010387640001Medicaid
20037019OtherAMERIHEALTH MERCY
PA0010387640001Medicaid
PA4558691OtherAETNA PPO POS