Provider Demographics
NPI:1215190350
Name:DILLON, DOUGLAS EVERETT (FPMHNP)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:EVERETT
Last Name:DILLON
Suffix:
Gender:M
Credentials:FPMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18TH MEDICAL GROUP
Mailing Address - Street 2:UNIT 5142
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96368
Mailing Address - Country:US
Mailing Address - Phone:315-634-3272
Mailing Address - Fax:
Practice Address - Street 1:18TH MEDICAL GROUP
Practice Address - Street 2:UNIT 5142
Practice Address - City:APO, AP
Practice Address - State:CA
Practice Address - Zip Code:96368
Practice Address - Country:US
Practice Address - Phone:315-634-3272
Practice Address - Fax:719-556-7399
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX723752363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health