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Individual

DR. LEE JORDON HERBST

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
201510
NY
207V00000X
Obstetrics & Gynecology Physician
Primary
MD065622L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0017074700002
PA
05
01861105
NY
01
160049894
RR MEDICARE PIN
PA
01
CC9269
RR MEDICARE GROUP
PA
01
GU039794
MEDICARE GROUP
PA
Enumeration date
03/06/2006
Last updated
03/11/2021
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