Individual
JOHN ALAN DETRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3400 CIVIC CENTER BLVD, 2ND FLOOR, SOUTH PAVILION, PHILADELPHIA, PA 19104-5127
(215) 662-3606
Mailing address
3400 CIVIC CENTER BLVD, 2ND FLOOR, SOUTH PAVILION, PHILADELPHIA, PA 19104-5127
(215) 662-3606
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
MD039705E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014597100001
—
PA
Enumeration date
07/10/2006
Last updated
08/10/2015
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