Individual
MR. GORDON DIETZ
Active
Individual
MR. GORDON DIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R103713
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007496140 0004
—
PA
01
—
050514
GROUP MEDICARE #
PA
01
—
RN326868L
RN LICENSE PA
PA
Enumeration date
05/23/2006
Last updated
09/16/2011
Update your record
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