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Individual

DR. GREGORY DEAN DIETRICH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
320 WARNER DRIVE, LEWISTON, ID 83501
(208) 743-3523
(208) 746-8741
Mailing address
320 WARNER DRIVE, LEWISTON, ID 83501
(208) 743-3523
(208) 746-8741

Taxonomy

Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
00034506
WA
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
M7482
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010004322
REGENCE
ID
01
74823
BCI
ID
05
805208800
ID
05
8204851
WA
Enumeration date
09/13/2005
Last updated
06/24/2016
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