Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 35 05 9424 | OH |
NPI | 1053426379 |
---|---|
Provider Name | Richard Alan Fricker |
First Address | Gastonia, NC 28054-4725 |
Second Address | Gastonia, NC 28054-4725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 19/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5904539 | (05) | NC |
F49443 | (02) | NC |
N00885 | (05) | SC |
P00351580 | RAILROAD MEDICARE (01) | NC |