Organization
BRIAN D DIETERLE MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN D DIETERLE M.D. (PRESIDENT)
(417) 334-0810
Entity
Organization
Contact information
Practice address
670 BRANSON LANDING BLVD STE 2, BRANSON, MO 65616-2063
(417) 334-0810
(417) 334-6685
Mailing address
670 BRANSON LANDING BLVD STE 2, BRANSON, MO 65616-2063
(417) 334-0810
(417) 334-6685
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
102259
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203602404
—
MO
Enumeration date
01/30/2008
Last updated
10/25/2023
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