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NPI Code Detail

MEDICARE: DR. SHAWN FRANK DIERTL MD

MEDICARE: DR. SHAWN FRANK DIERTL MD
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1437919974
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHAWN FRANK DIERTL MD
Provider Business Mailing Address
First Line : 1707 N MAIN ST
Second Line :
City : GAINESVILLE
State : FL
Zip : 32609-3650
Country : US
Telephone Number : 352-265-9593
Fax Number :
Provider Business Practice Location Address
First Line : 1707 N MAIN ST
Second Line :
City : GAINESVILLE
State : FL
Zip : 32609-3650
Country : US
Telephone Number : 352-265-9593
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2024
Last Update Date : 02/16/2026

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