Provider Demographics
NPI:1578527867
Name:DIBONA, FRANCIS J (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANCIS
Middle Name:J
Last Name:DIBONA
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 1:755 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-6306
Mailing Address - Country:US
Mailing Address - Phone:803-648-0718
Mailing Address - Fax:803-641-9143
Practice Address - Street 1:755 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6306
Practice Address - Country:US
Practice Address - Phone:803-648-0718
Practice Address - Fax:803-641-9143
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0256002080P0210X, 207RN0300X
SC11596207RN0300X, 2080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4213010OtherAETNA PROVIDER NUMBER
SC043723466OtherTRICARE PROVIDER NUMBER
SC115967Medicaid
SCB915097503Medicare ID - Type UnspecifiedPROVIDER NUMBER
SC043723466OtherTRICARE PROVIDER NUMBER
SC390008620Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER