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NPI Code Detail

MEDICARE: DR. JEAN D DIB M.D.

MEDICARE: DR. JEAN D DIB 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
1207R00000XInternal Medicine Physician35076500DOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477556686
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEAN D DIB M.D.
Provider Business Mailing Address
First Line : 22792 HARRISBURG WESTVILLE RD
Second Line :
City : ALLIANCE
State : OH
Zip : 44601-9224
Country : US
Telephone Number : 330-823-4000
Fax Number : 330-829-2919
Provider Business Practice Location Address
First Line : 22792 HARRISBURG WESTVILLE RD
Second Line :
City : ALLIANCE
State : OH
Zip : 44601-9224
Country : US
Telephone Number : 330-823-4000
Fax Number : 330-829-2919
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 04/11/2013

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