MEDICARE: JASON W DIMMIG 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	207W00000X	Ophthalmology Physician	MD25793	OR

General Provider Information

NPI Number	:	1568447035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON W DIMMIG M.D.

Provider Business Mailing Address
First Line	:	2275 NE DOCTORS DR
Second Line	:	SUITE 6
City	:	BEND
State	:	OR
Zip	:	97701-6324
Country	:	US
Telephone Number	:	541-389-3166
Fax Number	:

Provider Business Practice Location Address
First Line	:	2275 NE DOCTORS DR
Second Line	:	SUITE 6
City	:	BEND
State	:	OR
Zip	:	97701-6324
Country	:	US
Telephone Number	:	541-389-3166
Fax Number	:

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

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	07/08/2007

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