Individual
MBOUTIDEM ETOKAKPAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
50 MOISEY DR, HAZLE TOWNSHIP, PA 18202-9297
(570) 501-6900
(570) 501-6945
Mailing address
2100 MACK BLVD FL 4, ALLENTOWN, PA 18103-5622
(570) 501-6368
(570) 501-4754
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
35.138339
OH
208600000X
Surgery Physician
Primary
MD469829
PA
Other
Enumeration date
08/14/2014
Last updated
07/26/2022
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