Provider Demographics
NPI:1528052164
Name:JOHN J DALLMAN MD PA
Entity type:Organization
Organization Name:JOHN J DALLMAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JULIUS
Authorized Official - Last Name:DALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-937-9070
Mailing Address - Street 1:1501 S PINELLAS AVE
Mailing Address - Street 2:STE C
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-1955
Mailing Address - Country:US
Mailing Address - Phone:727-937-9070
Mailing Address - Fax:727-937-0087
Practice Address - Street 1:1501 S PINELLAS AVE
Practice Address - Street 2:STE C
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-1955
Practice Address - Country:US
Practice Address - Phone:727-937-9070
Practice Address - Fax:727-937-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32677207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E26056Medicare UPIN
FL01256Medicare ID - Type Unspecified