Individual
JAMES BRAD DIESTELHORST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
MD00041071
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0230369
L&I/CRIME VICTIMS
WA
05
—
1336148766
—
WA
01
—
4912DI
REGENCE
WA
01
—
7704353
AETNA
WA
01
—
MD4918W
ALASKA MEDICAID
AK
Enumeration date
07/18/2005
Last updated
09/22/2010
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