Provider Demographics
NPI:1154407534
Name:DILLON, KEITH OLIVER (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:OLIVER
Last Name:DILLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1510 E MAIN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4825
Mailing Address - Country:US
Mailing Address - Phone:805-739-3262
Mailing Address - Fax:805-354-7013
Practice Address - Street 1:1510 E MAIN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4825
Practice Address - Country:US
Practice Address - Phone:805-739-3262
Practice Address - Fax:805-354-7013
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2011-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75356207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI24660Medicare UPIN