Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 5758853-1205 | UT |
NPI | 1013054295 |
---|---|
Provider Name | Dr. Jeffrey David Dillon |
First Address | San Antonio, TX 78257-8207 |
Second Address | Salt Lake City, UT 84132-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 20/10/2021 |