Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 1463 | AL |
N | 207ND0900X | Dermatopathologist | 1463 | AL |
NPI | 1013973692 |
---|---|
Provider Name | Dr. Jeffrey B Stricker |
First Address | Panama City, FL 32405-4423 |
Second Address | Dothan, AL 36303-1908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2006 |
Last Update Date | 28/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102I076050 | MEDICARE (01) | AL |
H44588 | (02) |