Individual
RICHARD EDWARD DIETZEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
403 W OAK ST, SUITE 302, EL DORADO, AR 71730-4586
(870) 863-6444
(870) 863-6675
Mailing address
PO BOX 2116, EL DORADO, AR 71731-2116
(870) 863-6444
(870) 863-6675
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
E-1069
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130492001
—
AR
05
—
136119002
—
AR
Enumeration date
10/05/2005
Last updated
10/27/2010
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