Individual
DR. JOSHUA RYAN DIMMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1536 E PRIMROSE ST, SPRINGFIELD, MO 65804-7928
(417) 882-1818
Mailing address
1536 E PRIMROSE ST, SPRINGFIELD, MO 65804-7928
(417) 882-1818
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
2009004969
MO
207N00000X
Dermatology Physician
M8632
TX
207ND0900X
Dermatopathology Physician
2009004969
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285838847
—
MO
01
—
148380006
MISSOURI MEDICARE
MO
01
—
3857747604
MYUTMB 3857747604-COMMERCIAL NUMBER
—
Enumeration date
06/14/2007
Last updated
07/21/2022
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