Individual
RICHARD GRENVILLE DIEDRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1001 D W. BROADWAY, FARMINGTON, NM 87401
(505) 327-4796
Mailing address
116 PINE RIVER RANCH CIR, BAYFIELD, CO 81122-9325
(970) 884-4831
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
NM 80-29
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
27870
—
NM
Enumeration date
07/07/2006
Last updated
07/08/2007
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