Provider Demographics
NPI:1801254610
Name:DIETHELM, GERALDINE (VET MED)
Entity type:Individual
Prefix:DR
First Name:GERALDINE
Middle Name:
Last Name:DIETHELM
Suffix:
Gender:F
Credentials:VET MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 OVERSEAS HWY
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-2621
Mailing Address - Country:US
Mailing Address - Phone:305-743-7099
Mailing Address - Fax:305-743-4057
Practice Address - Street 1:5001 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2621
Practice Address - Country:US
Practice Address - Phone:305-743-7099
Practice Address - Fax:305-743-4057
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLVM7228174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian