Individual
DR. TIMOTHY JOHN DIETRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
1705 CLUB MANOR DRIVE,, SUITE 2, MAUMELLE, AR 72113-7401
(501) 851-7402
(501) 851-4753
Mailing address
1701 CLUB MANOR DRIVE, , SUITE 2, MAUMELLE, AR 72113-7401
(501) 851-7402
(501) 851-4753
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
E-3259
AR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/02/2013
Last updated
09/02/2016
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