Provider Demographics
NPI:1548507262
Name:MARLIN L. DIMOND, M.D.,P.C.
Entity type:Organization
Organization Name:MARLIN L. DIMOND, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-938-3742
Mailing Address - Street 1:5620 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE E-2
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4636
Mailing Address - Country:US
Mailing Address - Phone:602-938-3742
Mailing Address - Fax:602-938-0639
Practice Address - Street 1:5620 W THUNDERBIRD RD
Practice Address - Street 2:SUITE E-2
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4636
Practice Address - Country:US
Practice Address - Phone:602-938-3742
Practice Address - Fax:602-938-0639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14226174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ528667327Medicare UPIN