Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 071483 | GA |
NPI | 1003850496 |
---|---|
Provider Name | Dr. James Dallis |
First Address | Eglin Afb, FL 32542-1302 |
Second Address | Eglin Afb, FL 32542-1302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 11/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0003174622G | (05) | GA |