MEDICARE: CHRISTOS DIMAS 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
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	12525	OK

General Provider Information

NPI Number	:	1336245679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOS DIMAS MD

Provider Business Mailing Address
First Line	:	PO BOX 1910
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73144
Country	:	US
Telephone Number	:	405-682-0801
Fax Number	:	405-685-6260

Provider Business Practice Location Address
First Line	:	2716 SW 44TH
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73119
Country	:	US
Telephone Number	:	405-685-6260
Fax Number	:	405-685-6260

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/08/2007

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