Individual
DR. GORDON EDGAR WUEBBOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2 FARM COLONY DRIVE, WARREN, PA 16365-5206
(814) 726-2303
(814) 726-7459
Mailing address
2 FARM COLONY DRIVE, WARREN, PA 16365-5206
(814) 726-2303
(814) 726-7459
Taxonomy
Speciality
Code
Description
License number
State
156FX1100X
Ophthalmic Technician/Technologist
219642-1
NY
156FX1100X
Ophthalmic Technician/Technologist
MD052930L
PA
207W00000X
Ophthalmology Physician
219642-1
NY
207W00000X
Ophthalmology Physician
Primary
MD052930L
PA
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
219642-1
NY
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
MD052930L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001464588
—
PA
05
—
02155728
—
NY
Enumeration date
02/17/2006
Last updated
10/13/2021
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