Individual
DR. THOMPSON MACK DIETZ IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1495 GAUSE BLVD, SLIDELL, LA 70458-2205
(985) 405-5200
(985) 405-5201
Mailing address
PO BOX 8861, METAIRIE, LA 70011-8861
(985) 405-5200
(985) 405-5201
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
013772
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1323764
—
LA
Enumeration date
06/15/2005
Last updated
02/20/2008
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