Provider Demographics
NPI:1831122886
Name:DIERUF, WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:DIERUF
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 1:89 SYLVANIA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3281
Mailing Address - Country:US
Mailing Address - Phone:937-320-2020
Mailing Address - Fax:937-320-0504
Practice Address - Street 1:89 SYLVANIA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-3281
Practice Address - Country:US
Practice Address - Phone:937-320-2020
Practice Address - Fax:937-320-0504
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35032298D174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0140458Medicaid
OHA71465Medicare UPIN
OH0140458Medicaid