Basic Information
Provider Information
NPI: 1588089361
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DILLON
FirstName: WILLIAM
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: BOX 3887 DUMC
Address2:  
City: DURHAM
State: NC
PostalCode: 27701
CountryCode: US
TelephoneNumber: 9196846271
FaxNumber:  
Practice Location
Address1: 40 MEDICINE CIR
Address2: CLINIC 1I
City: DURHAM
State: NC
PostalCode: 277100001
CountryCode: US
TelephoneNumber: 9196846271
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/03/2014
LastUpdateDate: 04/24/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
231H00000X  Y Speech, Language and Hearing Service ProvidersAudiologist 

No ID Information.


Home