Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | OPP00030 | AR |
Y | 222Z00000X | Podiatrist | OPP00030 | AR |
N | 225000000X | Orthotic Fitter | C17466 |
NPI | 1154573863 |
---|---|
Provider Name | Mr. Albert Henry Ciccel JR. |
First Address | Jacksonville, AR 72076-3956 |
Second Address | North Little Rock, AR 72114-1709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2008 |
Last Update Date | 14/10/2008 |