Provider Demographics
NPI:1922131291
Name:DILLON, TERRY PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:PATRICK
Last Name:DILLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TERENCE
Other - Middle Name:PATRICK
Other - Last Name:DILLON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1901 OUTLET CENTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0663
Mailing Address - Country:US
Mailing Address - Phone:805-988-3200
Mailing Address - Fax:805-988-3707
Practice Address - Street 1:1901 OUTLET CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0663
Practice Address - Country:US
Practice Address - Phone:805-988-3200
Practice Address - Fax:805-988-3707
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG518142083P0500X, 208D00000X, 209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Not Answered209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E27798Medicare UPIN