Provider Demographics
NPI:1114690211
Name:DIETRICH, GERARD PRIGGEL
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:PRIGGEL
Last Name:DIETRICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4414 PENNSYLVANIA AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3326
Mailing Address - Country:US
Mailing Address - Phone:417-293-9682
Mailing Address - Fax:
Practice Address - Street 1:4320 WORNALL RD STE 65
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5945
Practice Address - Country:US
Practice Address - Phone:816-932-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program