Provider Demographics
NPI:1447598396
Name:KEITH DILLON, M.D., INC.
Entity Type:Organization
Organization Name:KEITH DILLON, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-739-3262
Mailing Address - Street 1:1510 E MAIN ST
Mailing Address - Street 2:STE 104
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4825
Mailing Address - Country:US
Mailing Address - Phone:805-739-3262
Mailing Address - Fax:805-354-7013
Practice Address - Street 1:1510 E MAIN ST
Practice Address - Street 2:STE 104
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4825
Practice Address - Country:US
Practice Address - Phone:805-739-3262
Practice Address - Fax:805-354-7013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75356207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI24660Medicare UPIN