Individual
DAVID DANIEL DIETERICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
455 PINELLAS ST, SUITE 400, CLEARWATER, FL 33756-3356
(727) 445-1991
(727) 445-1986
Mailing address
455 PINELLAS ST, SUITE 400, CLEARWATER, FL 33756-3356
(727) 445-1992
(727) 445-1993
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
053669
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
065988600
—
FL
01
—
82318X
MEDICARE PTAN
—
Enumeration date
10/18/2005
Last updated
10/26/2012
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