Provider Demographics
NPI:1417992041
Name:DIEGEL, PAUL L (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:DIEGEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 3RD ST SE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-4247
Mailing Address - Country:US
Mailing Address - Phone:701-253-5300
Mailing Address - Fax:701-253-5402
Practice Address - Street 1:1000 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-3250
Practice Address - Country:US
Practice Address - Phone:701-845-8060
Practice Address - Fax:701-845-8067
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND7956207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDHP30521OtherHEALTHPARTNERS #
ND004H1DIOtherMNBS #
ND004H2DIOtherMNBS #
ND004H4DIOtherMNBS #
ND26076OtherNDBS #
ND46793OtherLHS #
NDDA9061017278OtherPREFERRED ONE #
ND0121876OtherM,EDICAID #
ND11223Medicaid
ND0121878OtherMEDICAID #
ND990799OtherAMERICA'S PPO/ARAZ #
ND135567OtherUCARE #
ND0121877OtherMEDICA #
ND26077OtherNDBS #
ND0121879OtherMEDICA #
ND0121878OtherMEDICAID #
ND26077OtherNDBS #
ND711673Medicare ID - Type UnspecifiedND MEDICARE #