Individual
MARTIN LEE DIERKS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
2915 PARTHENON DR, DE SOTO, MO 63020-4645
(757) 650-8436
Mailing address
2915 PARTHENON DR, DE SOTO, MO 63020-4645
(757) 650-8436
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
10/17/2009
Last updated
10/17/2009
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