MEDICARE: BENEDICT S. DILLON M.D.

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	207R00000X	Internal Medicine Physician	A111118	CA

General Provider Information

NPI Number	:	1710142708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENEDICT S. DILLON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 459
Second Line	:
City	:	IMPERIAL BEACH
State	:	CA
Zip	:	91933
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 OUTER ROAD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92154
Country	:	US
Telephone Number	:	619-429-3733
Fax Number	:	619-628-5550

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

Provider Enumeration Date	:	07/19/2008
Last Update Date	:	04/11/2013

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