Provider Demographics
NPI:1043302136
Name:DIMAS, CALIXTO T (MD)
Entity Type:Individual
Prefix:DR
First Name:CALIXTO
Middle Name:T
Last Name:DIMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 116TH AVE NE
Mailing Address - Street 2:SUITE E
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3817
Mailing Address - Country:US
Mailing Address - Phone:425-250-1150
Mailing Address - Fax:425-823-6028
Practice Address - Street 1:1310 116TH AVE NE
Practice Address - Street 2:SUITE E
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3817
Practice Address - Country:US
Practice Address - Phone:425-250-1150
Practice Address - Fax:425-823-6028
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00325782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8176125Medicaid
WA8176125Medicaid
WAE61911Medicare UPIN