Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 20814 | AZ |
NPI | 1003802539 |
---|---|
Provider Name | Curtis A Dickman |
First Address | Phoenix, AZ 85013-4434 |
Second Address | Phoenix, AZ 85013-4434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 08/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110867 | (05) | AZ |
F28175 | (02) |