Provider Demographics
NPI:1639246754
Name:DIMOWO, JOHN ORUYOPITA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ORUYOPITA
Last Name:DIMOWO
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 1:5959 GATEWAY BLVD W
Mailing Address - Street 2:STE. 120
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3331
Mailing Address - Country:US
Mailing Address - Phone:915-779-1716
Mailing Address - Fax:
Practice Address - Street 1:11930 VISTA DEL SOL DR
Practice Address - Street 2:STE.B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6123
Practice Address - Country:US
Practice Address - Phone:915-430-3439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52501207L00000X
TXK4883207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A525010Medicaid
CABJ684Medicare PIN
CABJ684WMedicare PIN
F71489Medicare UPIN
CAP00728780Medicare PIN
CABJ684ZMedicare PIN