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NPI Code Detail

MEDICARE: DR. BERNHARD ERIC DIETZ M.D.

MEDICARE: DR. BERNHARD ERIC DIETZ M.D.
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
1207Q00000XFamily Medicine Physician27623TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13077257OTHERTNBC/BS OF TENNESSEE
27864OTHERTNTLC-MEMPHIS MANAGED CARE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
480121733OTHERTNMETRAHEALTH
55572559OTHERTNAETNA

General Provider Information

NPI Number : 1497759807
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BERNHARD ERIC DIETZ M.D.
Provider Business Mailing Address
First Line : 116 W MAIN ST
Second Line :
City : HENDERSON
State : TN
Zip : 38340-2231
Country : US
Telephone Number : 731-989-0001
Fax Number : 731-520-0064
Provider Business Practice Location Address
First Line : 116 W MAIN ST
Second Line :
City : HENDERSON
State : TN
Zip : 38340-2231
Country : US
Telephone Number : 731-824-2400
Fax Number : 731-824-0388
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 02/10/2021

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