Provider Demographics
NPI:1386047298
Name:UZODINMA RAPHAEL DIM MD, PA
Entity type:Organization
Organization Name:UZODINMA RAPHAEL DIM MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
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 DRIVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-9998
Mailing Address - Country:US
Mailing Address - Phone:915-248-2434
Mailing Address - Fax:915-248-2443
Practice Address - Street 1:2200 GEORGE DIETER DRIVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-9998
Practice Address - Country:US
Practice Address - Phone:915-248-2434
Practice Address - Fax:915-248-2443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0720207RC0000X, 207RC0001X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty