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General NPI Number Information
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NPI Number | 1174738397
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Entity Type | Organization
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Legal Business Name | RICHARD E. DIETZEN, M.D.,P.A.
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 403 W OAK ST SUITE 302
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City | EL DORADO
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State | AR
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Zip | 71730-4586
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Country | US
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Telephone | 870-863-6444
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Fax | 870-863-6675
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Provider Business Mailing Address
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Address Line | 403 W. OAK ST SUITE 302
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City | EL DORADO
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State | AR
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Zip | 71730-4586
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Country | US
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Telephone | 870-863-6444
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Fax | 870-863-6675
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. RICHARD EDWARD DIETZEN
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Credential | M.D.
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Telephone | 870-863-6444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | E-1069
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License Number State | AR
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