Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0011X | Interventional Cardiology | 30121 | IA |
NPI | 1083693949 |
---|---|
Provider Name | Dr. Eric J Dippel |
First Address | Palm Harbor, FL 34683-1930 |
Second Address | Davenport, IA 52807-3471 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 05/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060059569 | MEDICARE RAILROAD (01) | |
8114611 | (05) | IA |
F91926 | (02) | |
IB3877001 | VASCULAR INSTITUTE OF THE MIDWEST (01) | IA |