Provider Demographics
NPI:1477871374
Name:DIMON, MATTHEW RYAN (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RYAN
Last Name:DIMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S ANNISTON AVE
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2961
Mailing Address - Country:US
Mailing Address - Phone:256-207-0200
Mailing Address - Fax:256-207-0201
Practice Address - Street 1:110 S ANNISTON AVE
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2961
Practice Address - Country:US
Practice Address - Phone:256-207-0200
Practice Address - Fax:256-207-0201
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.34222208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery