Individual
COREY FEHR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1125 MOYERS STATION RD, PINE GROVE, PA 17963-9041
(570) 640-9350
Mailing address
1125 MOYERS STATION RD, PINE GROVE, PA 17963-9041
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
PT291062
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AJQAN6164486
BLUE CROSS BLUE SHIELD
PA
Enumeration date
03/15/2016
Last updated
03/15/2016
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