Individual
DR. JACK OLIVER WASEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA MSCI MSC BM BCH
Contact information
Practice address
3401 CIVIC CENTER BLVD, SUITE 9329, PHILADELPHIA, PA 19104-4319
(180) 087-9246
Mailing address
3401 CIVIC CENTER BLVD, SUITE 9329, PHILADELPHIA, PA 19104-4319
(215) 590-1858
(267) 425-9331
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
MT207967
PA
207LP3000X
Pediatric Anesthesiology Physician
Primary
MD457791
PA
207LP3000X
Pediatric Anesthesiology Physician
MT207967
PA
Other
Enumeration date
06/28/2011
Last updated
11/02/2016
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