Provider Demographics
NPI:1871687897
Name:DIEDRICHSEN, DAVID L (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:DIEDRICHSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PRINGLE WAY
Mailing Address - Street 2:SUITE 601
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1464
Mailing Address - Country:US
Mailing Address - Phone:775-326-8380
Mailing Address - Fax:775-786-8684
Practice Address - Street 1:75 PRINGLE WAY
Practice Address - Street 2:SUITE 601
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1464
Practice Address - Country:US
Practice Address - Phone:775-326-8380
Practice Address - Fax:775-786-8684
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV3056207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP00253305OtherRAILROAD MEDICARE
NVP00253305OtherRAILROAD MEDICARE
NVE73604Medicare UPIN