Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 0377 | AZ |
Y | 222Z00000X | Podiatrist | 0377 | AZ |
NPI | 1073506259 |
---|---|
Provider Name | Dr. Samuel Irwin Dolnick |
First Address | Prescott, AZ 86303-5766 |
Second Address | Prescott, AZ 86313-5001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T27448 | (02) |