Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | D76759 | MD |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | K8747 | TX |
NPI | 1043299852 |
---|---|
Provider Name | Dr. James R Ficke |
First Address | Baltimore, MD 21278-0006 |
Second Address | Baltimore, MD 21278-0006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 13/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D0076769 | MARYLAND LICENSE (01) | MD |
K8747 | PHYSICIAN LICENSE (01) | TX |