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General NPI Number Information
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NPI Number | 1154407534
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Entity Type | Individual
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Provider Name | KEITH OLIVER DILLON M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/28/2006
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Last Update Date | 07/10/2011
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Provider Practice Location Address
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Address Line | 1510 E MAIN ST SUITE 104
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City | SANTA MARIA
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State | CA
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Zip | 93454-4825
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Country | US
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Telephone | 805-739-3262
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Fax | 805-354-7013
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Provider Business Mailing Address
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Address Line | 1510 E MAIN ST SUITE 104
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City | SANTA MARIA
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State | CA
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Zip | 93454-4825
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Country | US
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Telephone | 805-739-3262
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Fax | 805-354-7013
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A75356
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License Number State | CA
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