Individual
DONALD DAVID DIETZE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
29301 N DIXIE RANCH RD, LACOMBE, LA 70445
(985) 871-4114
(985) 871-4130
Mailing address
29301 N DIXIE RANCH RD, LACOMBE, LA 70445
(985) 871-4114
(985) 871-4130
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
019033
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5E706
MEDICARE PROVIDER NUMBER
LA
Enumeration date
02/27/2006
Last updated
10/01/2015
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