Provider Demographics
NPI:1821394461
Name:DINAN, JEROME DARIO ALDO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JEROME
Middle Name:DARIO ALDO
Last Name:DINAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N CLARENCE NASH BLVD
Mailing Address - Street 2:
Mailing Address - City:WATONGA
Mailing Address - State:OK
Mailing Address - Zip Code:73772-2845
Mailing Address - Country:US
Mailing Address - Phone:580-623-7211
Mailing Address - Fax:
Practice Address - Street 1:500 N CLARENCE NASH BLVD
Practice Address - Street 2:
Practice Address - City:WATONGA
Practice Address - State:OK
Practice Address - Zip Code:73772-2845
Practice Address - Country:US
Practice Address - Phone:580-623-7211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-30
Last Update Date:2011-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2008363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant