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Individual

JOHN ANTHONY DIECK JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
4316 JAMES CASEY ST, BUILDING A, AUSTIN, TX 78745-1157
(512) 623-5300
(512) 623-5399
Mailing address
PO BOX 1509, SAN ANTONIO, TX 78295-1509
(512) 623-5300
(512) 623-5399

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
G8081
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
060012108
MEDICARE RAILROAD
TX
05
131632501
TX
05
131632507
TX
05
131632508
TX
01
8BX076
BCBSTX
TX
01
P00700180
MEDICARE RAILROAD
TX
01
P00706404
RAILROAD MEDICARE
TX
Enumeration date
08/02/2005
Last updated
06/24/2011
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