Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | OS10357 | FL |
NPI | 1326031014 |
---|---|
Provider Name | Herman W Dykes |
First Address | Temple Terrace, FL 33637-0925 |
Second Address | Temple Terrace, FL 33637-0925 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2005 |
Last Update Date | 01/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
281247900 | (05) | FL |
319161 | AVMED (01) | FL |
3602151 | CIGNA (01) | FL |
50487 | BLUECROSS BLUESHIELD (01) | FL |
7351464 | AETNA (01) | FL |
H70050 | (02) | |
P00779273 | MEDICARE RAILROAD (01) | FL |