Provider Demographics
NPI:1740291293
Name:DIETZ, MARK (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:DIETZ
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3687 VETERANS DR
Mailing Address - Street 2:FORT HARRISON VAMC
Mailing Address - City:FORT HARRISON
Mailing Address - State:MT
Mailing Address - Zip Code:59636-9703
Mailing Address - Country:US
Mailing Address - Phone:406-447-7708
Mailing Address - Fax:406-447-7991
Practice Address - Street 1:3687 VETERANS DR
Practice Address - Street 2:FORT HARRISON VAMC
Practice Address - City:FORT HARRISON
Practice Address - State:MT
Practice Address - Zip Code:59636-9703
Practice Address - Country:US
Practice Address - Phone:406-447-7708
Practice Address - Fax:406-447-7991
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2011-06-13
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Provider Licenses
StateLicense IDTaxonomies
MT85012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology