Stacey Dimitt, MD
Family Medicine in Grants, NM. Individual provider (NPI-1).
NPI number1508151978
StatusActive
Last updated in NPPESSep 2, 2020
Details
- NPI
- 1508151978
- Entity type
- Individual (NPI-1)
- Name
- Stacey Dimitt
- Credential
- MD
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 14, 2011
- Certification date
- Sep 2, 2020
- Last updated
- Sep 2, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 7613 | KS | Yes |
Practice location
1423 E Roosevelt AveGrants, NM 87020-2245
Phone 505-287-6500 · Fax 505-287-5393
Mailing address
1423 E Roosevelt AveGrants, NM 87020-2245
Phone 505-287-6500 · Fax 505-287-5393
Other practice locations
119 E Parliament St
Smith Center, KS 66967-3015
Smith Center, KS 66967-3015
Phone 316-962-3030
921 E Highway 36
Smith Center, KS 66967
Smith Center, KS 66967
Phone 785-282-6834 · Fax 785-282-3793
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