Individual
WAYNE DIEDRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3501 JOHNSON ST, HOLLYWOOD, FL 33021-5421
(954) 987-2020
Mailing address
PO BOX 862233, ORLANDO, FL 32886-2233
(954) 276-5575
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA3021
FL
Other
Enumeration date
08/13/2006
Last updated
07/08/2007
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