Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 036-058868 | IL |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 036-058868 | IL |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 036-058868 | IL |
NPI | 1417937632 |
---|---|
Provider Name | Dr. Alpheus T Appenheimer |
First Address | Dixon, IL 61021-3116 |
Second Address | Dixon, IL 61021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 27/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036058868 | (05) | IL |
C45310 | (02) |