MEDICARE: ROBERT J DIMEFF MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QS0010X	Sports Medicine (Family Medicine) Physician	N3619	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8HU421	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1003870718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT J DIMEFF MD

Provider Business Mailing Address
First Line	:	8210 WALNUT HILL LN STE 130
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4418
Country	:	US
Telephone Number	:	214-750-1207
Fax Number	:

Provider Business Practice Location Address
First Line	:	8081 WALNUT HILL LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4313
Country	:	US
Telephone Number	:	214-750-1207
Fax Number	:	214-739-5029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	03/17/2018

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