Provider Demographics
NPI:1821116260
Name:ANTONIO F. DIZON, M.D.
Entity Type:Organization
Organization Name:ANTONIO F. DIZON, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:F
Authorized Official - Last Name:DIZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:340-778-5780
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:CHRISTIANSTED
Mailing Address - City:ST.CROIX
Mailing Address - State:VI
Mailing Address - Zip Code:00820
Mailing Address - Country:US
Mailing Address - Phone:340-778-5780
Mailing Address - Fax:340-713-1870
Practice Address - Street 1:4500 ISLAND MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:ST.CROIX
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-778-5780
Practice Address - Fax:340-713-1870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI146207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0024359Medicare ID - Type Unspecified
F25178Medicare UPIN