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General NPI Number Information
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NPI Number | 1871974501
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Entity Type | Individual
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Provider Name | ADRIEL GENE DIZON MD
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Gender | Male
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 01/28/2019
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Provider Practice Location Address
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Address Line | 390 NORTH LOOP ROAD
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City | FORT IRWIN
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State | CA
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Zip | 92310
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Country | US
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Telephone | 760-383-5251
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Fax | 910-907-6099
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Provider Business Mailing Address
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Address Line | 2817 REILLY ROAD MCXC-COD CREDENTIALS WOMACK ARMY MEDICAL CENTER
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City | FORT BRAGG
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State | NC
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Zip | 28310-7324
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Country | US
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Telephone | 910-907-8922
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Fax | 910-907-6099
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01077764A
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License Number State | IN
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