Individual
DR. SHANE DENNIS DIECKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2501 CAPEHART RD, OFFUTT AFB, NE 68113-1043
(402) 294-2448
Mailing address
4102 PINION DR, USAF ACADEMY, CO 80840-2502
(719) 333-5115
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
305
NE
2085R0202X
Diagnostic Radiology Physician
DR.0055905
CO
Other
Enumeration date
08/26/2005
Last updated
10/15/2019
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