Provider Demographics
NPI:1891772562
Name:DILLON, HAROLD DEXTER III (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:DEXTER
Last Name:DILLON
Suffix:III
Gender:M
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:J. H. QUILLEN VETERANS AFFAIRS MEDICAL CENTER 112E
Mailing Address - Street 2:P.O. BOX 4000
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-4000
Mailing Address - Country:US
Mailing Address - Phone:423-926-1171
Mailing Address - Fax:423-979-3530
Practice Address - Street 1:J. H. QUILLEN VETERANS AFFAIRS MEDICAL CENTER 112E
Practice Address - Street 2:BUILDING 8, DOGWOOD AVENUE
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684-4000
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-3530
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27768174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC277685Medicaid
SCAA08797664Medicare PIN
SCI30940Medicare UPIN
SC277685Medicaid