Organization Name: | DIMITRI ORGERON MEDICAL, LLC |
NPI Number: | 1083059190 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ELIZABETH M. DIMITRI (PHYSICIAN/OWNER) |
Mailing Address: | 1506 N Mckenzie St Suite 106 Foley |
State: | AL US |
Postal Code: | 365352261 |
Phone Number: | 9856434512 |
Fax Number: | 9856434513 |
NPI Enumeration Date: | 05/02/2013 |
NPI Last Update Date: | 11/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 32590 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |