Provider Demographics
NPI:1336118801
Name:DILLING, JEROME M JR (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:M
Last Name:DILLING
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J
Other - Middle Name:M
Other - Last Name:DILLING
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:580-977-1907
Mailing Address - Fax:580-234-5161
Practice Address - Street 1:3201 N VAN BUREN ST
Practice Address - Street 2:SUITE 500
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-1812
Practice Address - Country:US
Practice Address - Phone:580-977-1907
Practice Address - Fax:580-234-5161
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9046207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100824500AMedicaid
OKP01318486OtherRR MEDICARE
OK100824500AMedicaid
OKP01318486OtherRR MEDICARE
OK249727408Medicare PIN