Provider Demographics
NPI:1073525838
Name:DIETZE, PAUL JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JAMES
Last Name:DIETZE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:715 N KANSAS
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-4452
Mailing Address - Country:US
Mailing Address - Phone:402-462-9009
Mailing Address - Fax:402-462-8090
Practice Address - Street 1:715 N KANSAS AVE STE 300
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4452
Practice Address - Country:US
Practice Address - Phone:402-462-9009
Practice Address - Fax:402-462-8090
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2020-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE17684207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E94566Medicare UPIN
NE266066DIMedicare PIN