MEDICARE: CHRIS DIMAS MD INC

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	261QP2300X	Primary Care Clinic/Center	12525	OK

General Provider Information

NPI Number	:	1689840647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRIS DIMAS MD INC

Provider Business Mailing Address
First Line	:	2716 SW 44TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73119-3339
Country	:	US
Telephone Number	:	405-682-0801
Fax Number	:	405-685-6260

Provider Business Practice Location Address
First Line	:	2716 SW 44TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73119-3339
Country	:	US
Telephone Number	:	405-682-0801
Fax Number	:	405-685-6260

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. GEORGIA DIMAS
Credential	:
Telephone Number	:	405-682-0801

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	04/30/2008

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