Individual
JONATHAN L DIETER JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8014 MYRTLE TRACE DR, CONWAY, SC 29526-8945
(843) 347-7224
(843) 347-7335
Mailing address
8014 MYRTLE TRACE DR, CONWAY, SC 29526-8945
(843) 347-7224
(843) 347-7335
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
7055
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PC4269
—
SC
Enumeration date
01/15/2007
Last updated
10/10/2007
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