John Dimaggio, DPM
Individual provider Active NPI Podiatrist · Bandon, OR
NPI 1497720973 · NPPES record last updated May 15, 2008
Key facts
- NPI
- 1497720973
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Podiatrist 213E00000X
- License
- DP00364 (OR)
- Practice address
- 913 11TH St SE
Suite 2
Bandon, OR 97411-9168 - Phone
- (541) 347-8283
- Fax
- (541) 347-3632
- NPI assigned
- Feb 20, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DP00364 | OR | MD | Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern Coos Health District | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | DP00364 | OR | Yes |
Addresses
Primary practice location
913 11TH St SE
Suite 2
Bandon, OR 97411-9168
Mailing address
913 11TH St SE
Suite 2
Bandon, OR 97411-9168
Phone (541) 347-8283
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 271038 | Medicaid | OR | |
| 840626000 | Other | OR | BCBS OF OR |
Other providers in Bandon, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 15, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.