Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 35-05-1217-D | OH |
NPI | 1043255060 |
---|---|
Provider Name | Arthur Peter Dick |
First Address | Lakewood, OH 44107-4214 |
Second Address | Lakewood, OH 44107-4214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 11/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0699749 | (05) | OH |
A17444 | (02) |