Provider Demographics
NPI:1588761571
Name:DIMAS, GREGORY PETER (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:PETER
Last Name:DIMAS
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:PO BOX 5422
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-5422
Mailing Address - Country:US
Mailing Address - Phone:708-366-3165
Mailing Address - Fax:
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD # 128
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4745
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:813-978-5913
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-106807208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX833819Medicare ID - Type Unspecified
TXC15273Medicare UPIN