Individual
DR. ERIC E. LIEDTKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4650 HARRISON BLVD, OGDEN, UT 84403-4303
(801) 475-3010
Mailing address
PO BOX 5546, DENVER, CO 80217-5546
(801) 475-3500
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
12168421-1204
UT
208600000X
Surgery Physician
20A12096
CA
208600000X
Surgery Physician
OP60582410
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366624330
—
UT
01
—
P01526646
RR MEDICARE
WA
Enumeration date
12/03/2007
Last updated
06/15/2021
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