Healthcare Provider Details

I. General information

NPI: 1003870718
Provider Name (Legal Business Name): ROBERT J DIMEFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8081 WALNUT HILL LN
DALLAS TX
75231-4313
US

IV. Provider business mailing address

8210 WALNUT HILL LN STE 130
DALLAS TX
75231-4418
US

V. Phone/Fax

Practice location:
  • Phone: 214-750-1207
  • Fax: 214-739-5029
Mailing address:
  • Phone: 214-750-1207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberN3619
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: