Provider Demographics
NPI:1982759254
Name:DILLON, THOMAS L (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:DILLON
Suffix:
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 1:780 SWIFT BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3524
Mailing Address - Country:US
Mailing Address - Phone:509-943-8558
Mailing Address - Fax:509-946-3262
Practice Address - Street 1:780 SWIFT BLVD
Practice Address - Street 2:STE 320
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3524
Practice Address - Country:US
Practice Address - Phone:509-943-8558
Practice Address - Fax:509-946-3262
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000190372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA17960OtherL&I PROVIDER#
WAMD00019037OtherWA STATE LICENSE
WA17960OtherL&I PROVIDER#