Provider Demographics
NPI:1780738427
Name:CARL F. DIENER, MD, PC
Entity type:Organization
Organization Name:CARL F. DIENER, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:F
Authorized Official - Last Name:DIENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-327-6267
Mailing Address - Street 1:5375 E ERICKSON DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2838
Mailing Address - Country:US
Mailing Address - Phone:520-327-6267
Mailing Address - Fax:520-321-0086
Practice Address - Street 1:5375 E ERICKSON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2838
Practice Address - Country:US
Practice Address - Phone:520-327-6267
Practice Address - Fax:520-321-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5462207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ230730Medicaid
AZAZ0056930OtherBCBSAZ
AZC99363Medicare UPIN
AZ0000BGCMLMedicare ID - Type Unspecified