Healthcare Provider Details

I. General information

NPI: 1578527867
Provider Name (Legal Business Name): FRANCIS J DIBONA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 MEDICAL PARK DR
AIKEN SC
29801-6306
US

IV. Provider business mailing address

755 MEDICAL PARK DR
AIKEN SC
29801-6306
US

V. Phone/Fax

Practice location:
  • Phone: 803-648-0718
  • Fax: 803-641-9143
Mailing address:
  • Phone: 803-648-0718
  • Fax: 803-641-9143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number025600
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number11596
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number025600
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number11596
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: