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General NPI Number Information
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NPI Number | 1306973615
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Entity Type | Individual
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Provider Name | RON DIECKMANN M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 09/29/2011
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Provider Practice Location Address
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Address Line | 5843 BUENA VISTA AVE
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City | OAKLAND
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State | CA
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Zip | 94618-2122
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Country | US
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Telephone | 510-213-1815
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Fax | 510-213-1815
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Provider Business Mailing Address
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Address Line | 5843 BUENA VISTA AVE
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City | OAKLAND
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State | CA
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Zip | 94618-2122
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Country | US
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Telephone | 510-213-1815
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Fax | 510-213-1815
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | G36970
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207PP0204X
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Taxonomy Name | Pediatric Emergency Medicine (Emergency Medicine) Physician
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License Number | G36970
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G36970
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License Number State | CA
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