Provider Demographics
NPI:1689840647
Name:CHRIS DIMAS MD INC
Entity Type:Organization
Organization Name:CHRIS DIMAS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-682-0801
Mailing Address - Street 1:2716 SW 44TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73119-3339
Mailing Address - Country:US
Mailing Address - Phone:405-682-0801
Mailing Address - Fax:405-685-6260
Practice Address - Street 1:2716 SW 44TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-3339
Practice Address - Country:US
Practice Address - Phone:405-682-0801
Practice Address - Fax:405-685-6260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12525261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD34585Medicare UPIN