MEDICARE: DR. GEORGE J. DIMITRI 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	008694	LA

Other Identifiers

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

General Provider Information

NPI Number	:	1639139314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE J. DIMITRI M.D.

Provider Business Mailing Address
First Line	:	701 METAIRIE RD
Second Line	:	# 205
City	:	METAIRIE
State	:	LA
Zip	:	70005-4050
Country	:	US
Telephone Number	:	504-837-3937
Fax Number	:	504-837-2814

Provider Business Practice Location Address
First Line	:	701 METAIRIE RD
Second Line	:	# 205
City	:	METAIRIE
State	:	LA
Zip	:	70005-4050
Country	:	US
Telephone Number	:	504-837-3937
Fax Number	:	504-837-2814

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

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	07/08/2007

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