Individual
PETER E DIEDRICHSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3772 43RD AVE, SUITE A, COLUMBUS, NE 68601-1681
(402) 563-3686
(402) 564-1797
Mailing address
PO BOX 1275, COLUMBUS, NE 68602-1681
(402) 563-3686
(402) 563-3084
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
14980
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01493
BLUE CROSS BLUE SHIELD
NE
05
—
47082635813
—
NE
Enumeration date
12/27/2005
Last updated
09/08/2023
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