Individual
GINGER L. DATTILO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
111 RIDGVIEW DR., BELLEVUE, ID 83313-0828
(720) 301-2055
Mailing address
PO BOX 828, BELLEVUE, ID 83313-0828
(720) 301-2055
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD20663
OR
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
43963
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
272459
—
OR
Enumeration date
11/10/2006
Last updated
05/15/2015
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