Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 12867 | AL |
NPI | 1225019706 |
---|---|
Provider Name | Dr. John Frank Dishuck |
First Address | Tuscaloosa, AL 35404-5751 |
Second Address | Tuscaloosa, AL 35404-5751 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 13/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
51083745 | BC/BS ALABAMA (01) | AL |
83745 | (05) | AL |
C76636 | (02) | AL |