Individual
DR. GREGG JEFFRY DIMMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
F0169
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124957502
—
TX
05
—
124957507
—
TX
01
—
370002795
RAILROAD GBA - RAILROAD MEDICARE
TX
01
—
820622
BC/BS TX #
TX
01
—
8DE526
BC/BS #
TX
Enumeration date
04/06/2006
Last updated
10/30/2012
Update your record
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