Provider Demographics
NPI:1184994501
Name:DIEHL, JAMES JEROME (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JEROME
Last Name:DIEHL
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 1:10530 W RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-4921
Mailing Address - Country:US
Mailing Address - Phone:952-944-0384
Mailing Address - Fax:
Practice Address - Street 1:10530 W RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-4921
Practice Address - Country:US
Practice Address - Phone:952-944-0384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN15978208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery