Individual
KEVIN DEIDRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 935-5750
Mailing address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(916) 390-1680
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
692126
TX
Other
Enumeration date
03/28/2021
Last updated
05/17/2024
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