Healthcare Provider Details

I. General information

NPI: 1063971356
Provider Name (Legal Business Name): DILLON OBERLIN SNYDER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2019
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 PRUDENTIAL DR
JACKSONVILLE FL
32207-8329
US

IV. Provider business mailing address

2121 PARK ST
JACKSONVILLE FL
32204-3811
US

V. Phone/Fax

Practice location:
  • Phone: 904-633-4199
  • Fax: 904-633-4188
Mailing address:
  • Phone: 904-387-6200
  • Fax: 904-633-4188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS18800
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: