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General NPI Number Information
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NPI Number | 1508825753
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Entity Type | Individual
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Provider Name | CORY LYNN DIETZ MD
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Gender | Male
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 700 W US HIGHWAY 24
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City | WOODLAND PARK
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State | CO
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Zip | 80863-8975
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Country | US
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Telephone | 719-522-1133
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Fax |
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Provider Business Mailing Address
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Address Line | 2 S CASCADE AVE STE 140
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-1604
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Country | US
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Telephone | 719-538-2900
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Fax | 719-538-2907
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 28289
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0053528
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License Number State | CO
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