Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 0935 | TX |
NPI | 1033197405 |
---|---|
Provider Name | Carlos A Dimidjian |
First Address | Big Spring, TX 79720 |
Second Address | Big Spring, TX 79720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 03/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110214703 | (05) | TX |
T13017 | (02) |