Individual
MR. JOHN BRETT DIETZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2602 SAINT MICHAEL DR STE 302B, TEXARKANA, TX 75503-5228
(903) 794-4196
(903) 614-5169
Mailing address
P O BOX 9600, DEPT 09-019, TEXARKANA, TX 75505-9600
(903) 794-4196
(903) 792-7408
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
K2152
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140006859
RAILROAD MEDICARE
TX
01
—
141100101
INDIGENT HEALTH CARE
—
05
—
141100101
—
TX
05
—
142238001
—
AR
01
—
179117500
US DEPT OF LABOR
—
01
—
1871793307
CIGNA DME
TX
01
—
18796000000
QUALCHOICE OF ARKANSAS
AR
01
—
1G1885
MEDICARE
TX
05
—
200023040A
—
OK
01
—
5575000001
CIGNA GOVERNMENT SERVICES
TX
01
—
8A0896
BLUE CROSS
TX
01
—
98601
BLUE CROSS
AR
01
—
98601
COLLUM & CARNEY CLINIC
TX
01
—
98601
FIRST PYRAMID LIFE
—
01
—
MDK2152
WORKERS' COMPENSATION
TX
Enumeration date
08/02/2005
Last updated
04/28/2021
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