Provider Demographics
NPI:1497720973
Name:DIMAGGIO, JOHN (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:DIMAGGIO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 11TH ST SE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411-9168
Mailing Address - Country:US
Mailing Address - Phone:541-347-8283
Mailing Address - Fax:541-347-3632
Practice Address - Street 1:913 11TH ST SE
Practice Address - Street 2:SUITE 2
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-9168
Practice Address - Country:US
Practice Address - Phone:541-347-8283
Practice Address - Fax:541-347-3632
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00364213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR271038Medicaid
OR840626000OtherBCBS OF OR
ORR134402Medicare PIN
OR840626000OtherBCBS OF OR
OR271038Medicaid