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General NPI Number Information
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NPI Number | 1083821748
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Entity Type | Organization
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Legal Business Name | ROBERT C DALZELL,MD PSC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2816 VEACH RD
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City | OWENSBORO
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State | KY
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Zip | 42303-6295
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Country | US
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Telephone | 270-926-2929
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Fax | 270-683-3290
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Provider Business Mailing Address
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Address Line | 2816 VEACH RD
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City | OWENSBORO
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State | KY
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Zip | 42303-6295
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Country | US
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Telephone | 270-926-2929
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Fax | 270-683-3290
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. PHYLLIS J SAALWACHTER
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Credential | ARNP
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Telephone | 270-926-2929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 167890
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License Number State | KY
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