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NPI Code Detail

MEDICARE: WILLIAM E DIETZE MD

MEDICARE: WILLIAM E DIETZE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistD4092TX
2207Y00000XOtolaryngology PhysicianD4092TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
175-2616977-113OTHERTXTRICARE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396740387
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM E DIETZE MD
Provider Business Mailing Address
First Line : PO BOX 846098
Second Line :
City : DALLAS
State : TX
Zip : 75284-6098
Country : US
Telephone Number : 903-324-6400
Fax Number :
Provider Business Practice Location Address
First Line : 115 AIRPORT RD
Second Line :
City : SULPHUR SPRINGS
State : TX
Zip : 75482-2105
Country : US
Telephone Number : 903-438-4670
Fax Number : 903-885-8720
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 09/26/2018

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