Provider Demographics
NPI:1760463103
Name:DONALD M. DILL, M.D.APC
Entity Type:Organization
Organization Name:DONALD M. DILL, M.D.APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:DILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-435-4229
Mailing Address - Street 1:171 C. AVE
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-4411
Mailing Address - Country:US
Mailing Address - Phone:619-435-4229
Mailing Address - Fax:619-435-4275
Practice Address - Street 1:171 C. AVE
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-4411
Practice Address - Country:US
Practice Address - Phone:619-435-4229
Practice Address - Fax:619-435-4275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X
CAC21783207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC21783OtherMEDICAL LICENSE