Provider Demographics
NPI:1871974501
Name:DIZON, ADRIEL GENE (MD)
Entity type:Individual
Prefix:
First Name:ADRIEL
Middle Name:GENE
Last Name:DIZON
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2817 REILLY ROAD MCXC-COD CREDENTIALS
Mailing Address - Street 2:WOMACK ARMY MEDICAL CENTER
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7324
Mailing Address - Country:US
Mailing Address - Phone:910-907-8922
Mailing Address - Fax:910-907-6099
Practice Address - Street 1:390 NORTH LOOP ROAD
Practice Address - Street 2:
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310
Practice Address - Country:US
Practice Address - Phone:760-383-5251
Practice Address - Fax:910-907-6099
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2019-01-28
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Provider Licenses
StateLicense IDTaxonomies
IN01077764A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty