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General NPI Number Information
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NPI Number | 1205943164
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Entity Type | Organization
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Legal Business Name | DIANE A SCHLICK DO LLC
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 08/02/2007
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Provider Practice Location Address
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Address Line | 616 S JEFFERSON ST
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City | PERRY
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State | FL
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Zip | 32347-4115
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Country | US
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Telephone | 850-584-5876
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Fax | 850-584-4939
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Provider Business Mailing Address
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Address Line | 616 S JEFFERSON ST
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City | PERRY
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State | FL
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Zip | 32347-4115
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Country | US
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Telephone | 850-584-5876
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Fax | 850-584-4939
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Authorized Official
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Title or Position | PROPRIETER
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Name | DIANE A SCHLICK
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Credential | DO
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Telephone | 850-584-5876
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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 | OS7860
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License Number State | FL
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