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NPI Code Detail

MEDICARE: DR. GREGG JEFFRY DIMMICK MD

MEDICARE: DR. GREGG JEFFRY DIMMICK MD
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
1208000000XPediatrics PhysicianF0169TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5370002795OTHERTXRAILROAD GBA - RAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2820622OTHERTXBC/BS TX #
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
48DE526OTHERTXBC/BS #

General Provider Information

NPI Number : 1013970680
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGG JEFFRY DIMMICK MD
Provider Business Mailing Address
First Line : 2100 REGIONAL MEDICAL DR
Second Line :
City : WHARTON
State : TX
Zip : 77488-9719
Country : US
Telephone Number : 979-532-1700
Fax Number : 979-532-6793
Provider Business Practice Location Address
First Line : 2100 REGIONAL MEDICAL DR
Second Line :
City : WHARTON
State : TX
Zip : 77488-9719
Country : US
Telephone Number : 979-532-1700
Fax Number : 979-532-6793
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2006
Last Update Date : 10/30/2012

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Directions to “ DR. GREGG JEFFRY DIMMICK MD” Practice Location

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