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General NPI Number Information
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NPI Number | 1548291354
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Entity Type | Individual
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Provider Name | FREDERICK J DAHL R.R.A. (ARRT)(R) RPA
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Gender | Male
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 830 S GLOSTER ST
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City | TUPELO
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State | MS
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Zip | 38801-4996
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Country | US
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Telephone | 662-377-5232
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Fax |
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Provider Business Mailing Address
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Address Line | 111 JEAN JANE LN
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City | TUPELO
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State | MS
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Zip | 38804-9113
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Country | US
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Telephone | 603-661-5485
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 243U00000X
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Taxonomy Name | Radiology Practitioner Assistant
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License Number | 09125
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2471V0106X
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Taxonomy Name | Vascular-Interventional Technology Radiologic Technologist
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License Number | 09125
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 243U00000X
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Taxonomy Name | Radiology Practitioner Assistant
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License Number | RA00005
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License Number State | MS
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