Healthcare Provider Details

I. General information

NPI: 1902294556
Provider Name (Legal Business Name): VICTOR DIZON, D.O., FACOS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

793 W STATE ST
COLUMBUS OH
43222-1551
US

IV. Provider business mailing address

PO BOX 117
NORTH OLMSTED OH
44070-0117
US

V. Phone/Fax

Practice location:
  • Phone: 614-234-5000
  • Fax:
Mailing address:
  • Phone: 888-808-6625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: VICTOR V DIZON
Title or Position: OWNER
Credential: D.O.
Phone: 614-234-5000