# MICHAEL A DIETER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1134198054
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA10002321 | WA | Yes |

## Other

- **Enumeration date:** 03/14/2006
- **Last updated:** 11/15/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000010149524 | REGENCE BLUE SHIELD OF ID | ID |
| 01 | — | 0156193 | DEPT OF LABOR & INDUSTRIE | WA |
| 01 | — | 379109600 | OWCP | WA |
| 01 | — | 4305DI | ASURIS NW HEALTH | WA |
| 01 | — | 5847 | GROUP HEALTH NW | WA |
| 05 | — | 806174800 | — | ID |
| 05 | — | 8387292 | — | WA |
| 01 | — | 8934606 | CRIME VICTIMS | WA |
| 01 | — | 970027249 | RR MEDICARE | WA |
| 01 | — | K6401 | BLUE CROSS OF ID | ID |