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NPI Code Detail

MEDICARE: MR. FREDERICK J DAHL R.R.A. (ARRT)(R) RPA

MEDICARE: MR. FREDERICK J DAHL R.R.A. (ARRT)(R) RPA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1243U00000XRadiology Practitioner Assistant09125MA
22471V0106XVascular-Interventional Technology Radiologic Technologist09125MA
3243U00000XRadiology Practitioner AssistantRA00005MS

General Provider Information

NPI Number : 1548291354
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. FREDERICK J DAHL R.R.A. (ARRT)(R) RPA
Provider Business Mailing Address
First Line : 111 JEAN JANE LN
Second Line :
City : TUPELO
State : MS
Zip : 38804-9113
Country : US
Telephone Number : 603-661-5485
Fax Number :
Provider Business Practice Location Address
First Line : 830 S GLOSTER ST
Second Line :
City : TUPELO
State : MS
Zip : 38801-4996
Country : US
Telephone Number : 662-377-5232
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2006
Last Update Date : 01/29/2025

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