1154385342 NPI number — DR. WILLIAM H DILLON DO

Table of content: DR. WILLIAM H DILLON DO (NPI 1154385342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154385342 NPI number — DR. WILLIAM H DILLON DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DILLON
Provider First Name:
WILLIAM
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154385342
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4101 EVANS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33901-9310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-335-1944
Provider Business Mailing Address Fax Number:
239-939-1575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1320 N 15TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IMMOKALEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34142-2875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-657-4486
Provider Business Practice Location Address Fax Number:
239-657-4770
Provider Enumeration Date:
04/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  059910 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: OS8086 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 47903 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4472251 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4370751 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 235465200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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