Provider Demographics
NPI:1821062514
Name:DILLON, JEANNE C (MD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:C
Last Name:DILLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 BROADWAY N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-3641
Mailing Address - Country:US
Mailing Address - Phone:701-234-2261
Mailing Address - Fax:
Practice Address - Street 1:801 BROADWAY N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-3641
Practice Address - Country:US
Practice Address - Phone:701-234-2261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5030207R00000X
ND10868207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0555144Medicaid
MN200896300Medicaid
SD57105F009OtherWPS TRICARE
MN135M7DIOtherCC SYSTEMS/ BLUE PLUS
SD5030OtherDAKOTACARE
SD0040350OtherBLUE CROSS
SD0404738OtherMEDICA
MN141730OtherUCARE
SD25566OtherSANFORD HEALTH PLAN
NE46022474335Medicaid
SD769201031092OtherPREFERRED ONE
SDHP37118OtherHEALTHPARTNERS
SD1650053OtherARAZ/ AMERICA'S PPO
SD236597OtherMIDLANDS CHOICE
MN92411422901OtherPRIMEWEST
SD110237698OtherRR MEDICARE
SD6004370Medicaid
SD5030OtherDAKOTACARE
SD236597OtherMIDLANDS CHOICE