Healthcare Provider Details

I. General information

NPI: 1821116260
Provider Name (Legal Business Name): ANTONIO F. DIZON, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 ISLAND MEDICAL CENTER
ST.CROIX VI
00820
US

IV. Provider business mailing address

PO BOX 629 CHRISTIANSTED
ST.CROIX VI
00820
US

V. Phone/Fax

Practice location:
  • Phone: 340-778-5780
  • Fax: 340-713-1870
Mailing address:
  • Phone: 340-778-5780
  • Fax: 340-713-1870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number146
License Number StateVI

VIII. Authorized Official

Name: ANTONIO F DIZON
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 340-778-5780