Provider Demographics
NPI:1215312772
Name:DIMACHK, MOUSTAPHA (MD)
Entity type:Individual
Prefix:DR
First Name:MOUSTAPHA
Middle Name:
Last Name:DIMACHK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 CHASE AVE
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2924
Mailing Address - Country:US
Mailing Address - Phone:095-897-3790
Mailing Address - Fax:509-897-5558
Practice Address - Street 1:380 CHASE AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2924
Practice Address - Country:US
Practice Address - Phone:095-897-3790
Practice Address - Fax:509-897-5558
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61595905208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery