Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 00025872 | AL |
NPI | 1063508083 |
---|---|
Provider Name | Dr. Isadore M. Pike |
First Address | Fairhope, AL 36532-2521 |
Second Address | Fairhope, AL 36532-2521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C 85992 | (02) |