Provider Demographics
NPI:1437291598
Name:DIETER, KAY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:LYNN
Last Name:DIETER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:LYNN
Other - Last Name:SCHWARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7222 FIELDVIEW ST NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-7216
Mailing Address - Country:US
Mailing Address - Phone:503-390-4350
Mailing Address - Fax:
Practice Address - Street 1:SKYLINE MEDICAL OFFICE
Practice Address - Street 2:5125 SKYLINE RD S
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-9427
Practice Address - Country:US
Practice Address - Phone:503-588-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR MD166572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry