Provider Demographics
NPI:1356456362
Name:FLEMING, DALLAS JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:DALLAS
Middle Name:JOHN
Last Name:FLEMING
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 1:970 E WASHINGTON ST
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3332
Mailing Address - Country:US
Mailing Address - Phone:330-721-5700
Mailing Address - Fax:330-721-5798
Practice Address - Street 1:970 E WASHINGTON ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3332
Practice Address - Country:US
Practice Address - Phone:330-721-5700
Practice Address - Fax:330-721-5798
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-068617207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0273172Medicaid
OH7422821Medicare PIN
OH0877642Medicare PIN
OH0273172Medicaid