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Individual
RUSSELL C PIETZ
Active
Individual
RUSSELL C PIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4105
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11631
—
ND
05
—
6003202
—
SD
05
—
6003203
—
SD
Enumeration date
06/09/2005
Last updated
09/28/2016
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