Healthcare Provider Details

I. General information

NPI: 1598857583
Provider Name (Legal Business Name): RICHARD A DIMOND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY COMPENSATION AND PENSION CLINIC 5 136 C&P
SEATTLE WA
98108
US

IV. Provider business mailing address

2140 BROADMOOR DR E
SEATTLE WA
98112
US

V. Phone/Fax

Practice location:
  • Phone: 206-764-2140
  • Fax: 206-277-4491
Mailing address:
  • Phone: 206-323-4929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberMD00010092
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: