Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 17963 | AZ |
N | 111NI0900X | Internist | 17963 | AZ |
Y | 207RA0401X | Internist - Addiction Medicine | 17963 | AZ |
N | 207RG0300X | Geriatric Medicine | 17963 | AZ |
N | 207RI0200X | Infectious Disease | 17963 | AZ |
NPI | 1962497693 |
---|---|
Provider Name | Dr. Leonard F Ditmanson |
First Address | Tucson, AZ 85754-6537 |
Second Address | Tucson, AZ 85714-1859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 10/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E45416 | (02) | AZ |