Individual
JACOB WILT UFBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3401 N BROAD STREET, TEMPLE UNIVERSITY HOSPITAL, PHILADELPHIA, PA 19140
(215) 707-5030
(215) 707-3494
Mailing address
2450 W HUNTING PARK AVE, PHILADELPHIA, PA 19129-1302
(215) 707-5030
(215) 707-3494
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD066368L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017499710001
—
PA
01
—
0192907000
INDEPENDENCE BC
PA
01
—
472534
HIGHMARK BS
PA
Enumeration date
03/14/2006
Last updated
03/21/2017
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