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General NPI Number Information
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NPI Number | 1619925401
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Entity Type | Individual
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Provider Name | MARVIN LEROY DIETRICH M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 01/11/2026
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Provider Practice Location Address
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Address Line | 10503 W THUNDERBIRD BLVD #301
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City | SUN CITY
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State | AZ
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Zip | 85351-3022
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Country | US
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Telephone | 623-974-3647
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Fax | 623-977-0310
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Provider Business Mailing Address
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Address Line | 18922 E TONTO VERDE DR
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City | RIO VERDE
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State | AZ
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Zip | 85263-5200
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Country | US
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Telephone | 480-471-3426
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Fax | 480-471-3428
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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 | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 27044
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License Number State | AZ
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