=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598857583
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD A DIMOND MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1660 S COLUMBIAN WAY COMPENSATION AND PENSION CLINIC 5 136 C&P
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-764-2140
-----------------------------------------------------
Fax | 206-277-4491
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2140 BROADMOOR DR E
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-323-4929
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0114X
-----------------------------------------------------
Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | MD00010092
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------