Provider Demographics
NPI:1114140811
Name:DAHL, ERIC JAMES (DO)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JAMES
Last Name:DAHL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 405
Mailing Address - Street 2:BOX 1998
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09034
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LANDSTUHL REGIONAL MEDICAL CENTER (BAUMHOLDER CLINIC)
Practice Address - Street 2:CMR 402
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180
Practice Address - Country:DE
Practice Address - Phone:4967-836-6383
Practice Address - Fax:4967-836-6721
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9869208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice