Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 5473 | FL |
NPI | 1164750592 |
---|---|
Provider Name | Dr. James Donald Dishman |
First Address | Daytona Beach Shores, FL 32118-4683 |
Second Address | Daytona Beach Shores, FL 32118-4683 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2009 |
Last Update Date | 23/11/2009 |