Basic Information
| Provider Information | |||||||||
| NPI: | 1073506259 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOLNICK | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | IRWIN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3035 RAINBOW RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863035766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284431712 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 500 N US HIGHWAY 89 | ||||||||
| Address2: | 5TH FLOOR SURGERY | ||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863135001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284454860 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 0377 | AZ | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.