Provider Demographics
NPI:1285838847
Name:DIMMICK, JOSHUA RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:RYAN
Last Name:DIMMICK
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 1:1536 E PRIMROSE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7928
Mailing Address - Country:US
Mailing Address - Phone:417-882-1818
Mailing Address - Fax:
Practice Address - Street 1:1536 E PRIMROSE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7928
Practice Address - Country:US
Practice Address - Phone:417-882-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8632207N00000X
MO2009004969207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1285838847Medicaid
3857747604OtherMYUTMB 3857747604-COMMERCIAL NUMBER
MO148380006OtherMISSOURI MEDICARE
MO1285838847Medicaid