Individual
GARY P DILLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 SALEM ST, LAFAYETTE, IN 47904-2164
(765) 448-8000
(765) 448-7029
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
Primary
01024462A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000340592
ANTHEM
IN
01
—
000000705135
ANTHEM PROVIDER PIN / TIN 35-2030653
IN
05
—
100340440
—
IN
Enumeration date
07/31/2006
Last updated
10/01/2013
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