Basic Information
| Provider Information | |||||||||
| NPI: | 1215190350 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DILLON | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | EVERETT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | FPMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18TH MEDICAL GROUP | ||||||||
| Address2: | UNIT 5142 | ||||||||
| City: | APO | ||||||||
| State: | AP | ||||||||
| PostalCode: | 96368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3156343272 | ||||||||
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| Practice Location | |||||||||
| Address1: | 18TH MEDICAL GROUP | ||||||||
| Address2: | UNIT 5142 | ||||||||
| City: | APO, AP | ||||||||
| State: | CA | ||||||||
| PostalCode: | 96368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3156343272 | ||||||||
| FaxNumber: | 7195567399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2008 | ||||||||
| LastUpdateDate: | 10/29/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 723752 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.