Individual
JERRY FORREST MIKESELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1393 N ATHERTON ST, STATE COLLEGE, PA 16803-2932
(814) 238-6097
(814) 238-5527
Mailing address
1393 N ATHERTON ST, STATE COLLEGE, PA 16803-2932
(814) 238-6097
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD033134E
PA
Other
Enumeration date
10/04/2006
Last updated
08/29/2007
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