Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 28282 | AZ |
N | 2081P2900X | Pain Medicine | 28282 | AZ |
NPI | 1114920675 |
---|---|
Provider Name | Gary J. Dilla |
First Address | Phoenix, AZ 85020-4330 |
Second Address | Phoenix, AZ 85020-4330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 10/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G02152 | (02) |