Provider Demographics
NPI:1164881397
Name:DILLON, LUKE MAXWELL (MD)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:MAXWELL
Last Name:DILLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LUIS
Other - Middle Name:JUAREZ
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CALLE PADRE UGARTE #3260,
Mailing Address - Street 2:
Mailing Address - City:OTAY
Mailing Address - State:BAJA CALIFORNIA
Mailing Address - Zip Code:22306
Mailing Address - Country:MX
Mailing Address - Phone:01152664-378-8866
Mailing Address - Fax:
Practice Address - Street 1:CALLE PADRE UGARTE #3260,
Practice Address - Street 2:
Practice Address - City:OTAY
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22306
Practice Address - Country:MX
Practice Address - Phone:01152664-378-8866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ5397028207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine