Provider Demographics
NPI:1700834819
Name:DILLOW, JOHN WILLIAM (BA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:DILLOW
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 623
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-0149
Mailing Address - Country:US
Mailing Address - Phone:503-492-8000
Mailing Address - Fax:503-492-8444
Practice Address - Street 1:735 SE MOUNT HOOD HWY
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-9156
Practice Address - Country:US
Practice Address - Phone:503-492-8000
Practice Address - Fax:503-492-8444
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-063663237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR011465Medicaid
OR865273000OtherBLUE CROSS BLUE SHEILD
OR011465Medicaid