Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 9400044 | NC |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 9400044 | NC |
NPI | 1376514521 |
---|---|
Provider Name | Dr. Edward Ernest Dickerson, Iv |
First Address | Bryson City, NC 28713-2814 |
Second Address | Fayetteville, NC 28304-3983 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 14/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89129FP | (05) | NC |
I06260 | (02) |