Individual
GARRY P. DIETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
UCLA DEPT ANESTHESIOLOGY AND PERIOP MEDICINE, LOS ANGELES, CA 90095-3129
(310) 267-8653
Mailing address
757 WESTWOOD PLZ STE 3304, LOS ANGELES, CA 90095-9780
(310) 267-0902
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
9767
MT
207LP2900X
Pain Medicine (Anesthesiology) Physician
9767
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0043771
—
MT
05
—
0080240
—
MT
05
—
806528000
—
ID
05
—
8409377
—
WA
Enumeration date
07/09/2006
Last updated
09/08/2021
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