MEDICARE: MR. MARLIN LEE DIMOND M.D.

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	174400000X	Specialist	14226	AZ

General Provider Information

NPI Number	:	1194795229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARLIN LEE DIMOND M.D.

Provider Business Mailing Address
First Line	:	5620 W THUNDERBIRD RD
Second Line	:	SUITE E-2
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4636
Country	:	US
Telephone Number	:	602-938-3742
Fax Number	:	602-938-0639

Provider Business Practice Location Address
First Line	:	5620 W THUNDERBIRD RD
Second Line	:	SUITE E-2
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4636
Country	:	US
Telephone Number	:	602-938-3742
Fax Number	:	602-938-0639

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	07/02/2013

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