Individual
THOMAS RUSSELL DIETZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5402 S STAPLES ST, SUITE 100, CORPUS CHRISTI, TX 78411-4656
(361) 992-9400
(361) 992-8295
Mailing address
5402 S STAPLES ST, SUITE 100, CORPUS CHRISTI, TX 78411-4656
(361) 992-9400
(361) 992-8295
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
H1574
TX
207WX0120X
Cornea and External Diseases Specialist Physician
H1574
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129833303
—
TX
Enumeration date
11/14/2005
Last updated
02/28/2019
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