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General NPI Number Information
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NPI Number | 1033197405
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Entity Type | Individual
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Provider Name | CARLOS A DIMIDJIAN DPM
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Gender | Male
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 1608 W FM 700 STE B
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City | BIG SPRING
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State | TX
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Zip | 79720
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Country | US
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Telephone | 432-267-1441
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Fax | 432-267-1442
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Provider Business Mailing Address
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Address Line | 1608 W FM 700 STE B
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City | BIG SPRING
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State | TX
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Zip | 79720
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Country | US
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Telephone | 432-267-1441
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Fax | 432-267-1442
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 0935
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License Number State | TX
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