Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | K4676 | TX |
NPI | 1720029218 |
---|---|
Provider Name | Dennis Dilley |
First Address | San Antonio, TX 78230-4779 |
Second Address | San Antonio, TX 78230-4779 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 08/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
030374502 | (05) | TX |
G68858 | (02) |