Individual
JOHN DIETRICK III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3000 MEDICAL PARK DR, SUITE 330, TAMPA, FL 33613-4680
(813) 971-2470
(813) 971-2491
Mailing address
1904 W MORRISON AVE, TAMPA, FL 33606-2831
(813) 258-9864
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME88224
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
273011100
—
FL
Enumeration date
10/25/2006
Last updated
12/19/2008
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