Provider Demographics
NPI:1356449086
Name:DIMSON, OTOBIA GIFTY (MD)
Entity Type:Individual
Prefix:
First Name:OTOBIA
Middle Name:GIFTY
Last Name:DIMSON
Suffix:
Gender:F
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:PO BOX 268945
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8945
Mailing Address - Country:US
Mailing Address - Phone:405-521-1969
Mailing Address - Fax:405-521-1979
Practice Address - Street 1:5005 N PENNSYLVANIA AVE STE 105
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8886
Practice Address - Country:US
Practice Address - Phone:405-848-2890
Practice Address - Fax:405-848-2809
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24254207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1831228576OtherGROUP NPI
OK245711101Medicare PIN
OKI29165Medicare UPIN