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Individual

MR. MARK J. DIERCKS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1111 NORTH 13TH STREET, SUITE 207, OMAHA, NE 68102-4251
(402) 348-1996
(402) 348-1879
Mailing address
1111 NORTH 13TH STREET, SUITE 207, OMAHA, NE 68102-4251
(402) 348-1996
(402) 348-1879

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
16137
NE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
47068181100
NE
Enumeration date
12/20/2006
Last updated
03/21/2019
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