Healthcare Provider Details

I. General information

NPI: 1174559124
Provider Name (Legal Business Name): ROBERT REX DIETZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: R REX DIETZ MD

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 12TH AVE N SUITE 210W
BILLINGS MT
59101-7506
US

IV. Provider business mailing address

4793 US HIGHWAY 3
BILLINGS MT
59106-9676
US

V. Phone/Fax

Practice location:
  • Phone: 406-237-5862
  • Fax: 406-238-6068
Mailing address:
  • Phone: 406-237-5862
  • Fax: 406-238-6068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number7277
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number7277
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: