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General NPI Number Information
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NPI Number | 1487674776
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Entity Type | Individual
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Provider Name | LAURA R DIMMICK MD
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Gender | Female
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 820 PRUDENTIAL DR STE 713
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8209
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Country | US
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Telephone | 904-396-5682
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Fax | 904-346-0864
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Provider Business Mailing Address
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Address Line | 8649 AUTUMN GREEN DR
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City | JACKSONVILLE
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State | FL
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Zip | 32256-9560
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Country | US
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Telephone | 904-476-6438
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME73498
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License Number State | FL
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