Provider Demographics
NPI:1346354917
Name:VON FELDMANN, DIETRICH (MD)
Entity Type:Individual
Prefix:DR
First Name:DIETRICH
Middle Name:
Last Name:VON FELDMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 E PRATER WAY STE 304
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-9639
Mailing Address - Country:US
Mailing Address - Phone:775-336-2777
Mailing Address - Fax:775-336-2803
Practice Address - Street 1:2345 E PRATER WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-9600
Practice Address - Country:US
Practice Address - Phone:775-336-2777
Practice Address - Fax:775-336-2803
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12002207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV12002OtherMEDICAL LICENSE
WAMD00013637OtherMEDICAL LICENSE