Provider Demographics
NPI:1689491623
Name:UZODINMA RAPHAEL DIM MD, PA
Entity type:Organization
Organization Name:UZODINMA RAPHAEL DIM MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:UZODINMA
Authorized Official - Middle Name:RAPHAEL
Authorized Official - Last Name:DIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-248-2434
Mailing Address - Street 1:2200 GEORGE DIETER DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3915
Mailing Address - Country:US
Mailing Address - Phone:915-248-2434
Mailing Address - Fax:
Practice Address - Street 1:2200 GEORGE DIETER DR STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-3915
Practice Address - Country:US
Practice Address - Phone:915-248-2434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UZODINMA RAPHAEL DIM MD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac Facilities
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty