MEDICARE: DR. JEFFREY JOSEPH DIETZENBACH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MD-36937	IA

General Provider Information

NPI Number	:	1306882527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY JOSEPH DIETZENBACH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 424
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50302-0424
Country	:	US
Telephone Number	:	515-875-9925
Fax Number	:	515-875-9923

Provider Business Practice Location Address
First Line	:	5950 UNIVERSITY AVE STE 135
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-8232
Country	:	US
Telephone Number	:	515-875-9795
Fax Number	:	515-875-9796

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	12/20/2023

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