Provider Demographics
NPI:1801989439
Name:DIAL, CHRISTINA L (DO)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:L
Last Name:DIAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1066
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39158-1066
Mailing Address - Country:US
Mailing Address - Phone:601-813-8133
Mailing Address - Fax:601-936-0088
Practice Address - Street 1:230 TRACE COLONY
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-8810
Practice Address - Country:US
Practice Address - Phone:601-936-8999
Practice Address - Fax:601-936-0088
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS18187208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00480330Medicaid
MS00480330Medicaid