Individual
DR. DARRELL R PIETSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6600 FISH POND RD STE 202A, WACO, TX 76710-2582
(254) 732-6789
(254) 732-6790
Mailing address
6600 FISH POND RD STE 202A, WACO, TX 76710-2582
(254) 732-6789
(254) 732-6790
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
K7867
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103631103
—
TX
05
—
103631105
—
TX
01
—
8BZ212
BCBS
TX
01
—
8L10057
MEDICARE
TX
Enumeration date
06/15/2005
Last updated
01/08/2010
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