Provider Demographics
NPI:1679569685
Name:DIEDE, JAMES H (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:DIEDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:11024 N 28TH DR
Mailing Address - Street 2:SUIT 160
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4377
Mailing Address - Country:US
Mailing Address - Phone:602-863-3924
Mailing Address - Fax:602-863-3926
Practice Address - Street 1:11024 N 28TH DR
Practice Address - Street 2:STE:160
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4377
Practice Address - Country:US
Practice Address - Phone:602-863-3924
Practice Address - Fax:602-863-3926
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ18915174400000X, 208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ349185Medicaid
AZ349185Medicaid
AZF65542Medicare UPIN