Provider Demographics
NPI:1295705283
Name:DILLON, JANE T (MD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:T
Last Name:DILLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15280 NW 79TH CT STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5873
Mailing Address - Country:US
Mailing Address - Phone:305-558-3732
Mailing Address - Fax:786-907-4485
Practice Address - Street 1:1050 W GRANADA BLVD STE 4
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8155
Practice Address - Country:US
Practice Address - Phone:386-677-8808
Practice Address - Fax:386-677-9919
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-070081207Y00000X
FLME139526207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMXWIAOtherFLORIDA BLUE
IL2233012OtherBLUE SHIELD
IL036070081Medicaid
IL036070081Medicaid