Provider Demographics
NPI:1952468274
Name:DIEHL, DELFRED LAURIE CHRIS (MD, FRCSC)
Entity Type:Individual
Prefix:
First Name:DELFRED
Middle Name:LAURIE CHRIS
Last Name:DIEHL
Suffix:
Gender:M
Credentials:MD, FRCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34581
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1581
Mailing Address - Country:US
Mailing Address - Phone:206-326-3131
Mailing Address - Fax:206-326-2094
Practice Address - Street 1:310 15TH AVE E
Practice Address - Street 2:GROUP HEALTH COOPERATIVE: OPHTHALMOLOGY CNB-5
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-5103
Practice Address - Country:US
Practice Address - Phone:206-326-3131
Practice Address - Fax:206-326-2094
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026231207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8116014Medicaid
WAG8880815Medicare PIN
WAP00275654Medicare PIN
WAGAB19105Medicare PIN
WAGAB19106Medicare PIN
WAGAB39085Medicare PIN
WA8116014Medicaid
WAGAB19107Medicare PIN
WAG000135730Medicare PIN