Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | MC10997 | DC |
NPI | 1578684817 |
---|---|
Provider Name | Mr. Dennis Scurry JR. |
First Address | Washington, DC 20011-1137 |
Second Address | Washington, DC 20011-1137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B93455 | (02) |