Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 038677 | CT |
N | 111NI0900X | Internist | 038677 | CT |
Y | 207R00000X | Internist | 38677 | CT |
Y | 111NI0900X | Internist | 38677 | CT |
N | 207RH0000X | Hematologist | 199769 | MD |
N | 207RX0202X | Medical Oncology | 199769 | MD |
NPI | 1194769315 |
---|---|
Provider Name | Dr. Frank Eckhard Dalichow |
First Address | Tuba City, AZ 86045-0600 |
Second Address | Tuba City, AZ 86045-0600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 14/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
524761 | (05) | AZ |
H43730 | (02) |