Provider Demographics
NPI:1194845586
Name:DIETER, ROBERT D (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:D
Last Name:DIETER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 W CATALDO AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2217
Mailing Address - Country:US
Mailing Address - Phone:509-624-2326
Mailing Address - Fax:
Practice Address - Street 1:217 W CATALDO AVE FL 2
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2217
Practice Address - Country:US
Practice Address - Phone:509-624-2326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3088363AM0700X
WAPA61313053363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS87019Medicare UPIN
CU263AMedicare PIN