Individual
WILLIAM G DIETRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 SHIRCLIFF WAY, JACKSONVILLE, FL 32204-4748
(989) 356-7390
Mailing address
PO BOX 863026, ORLANDO, FL 32886-3026
(800) 288-8325
(419) 866-5453
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME55253
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
055296800
—
FL
01
—
12806
BCBS
FL
01
—
930051064
RRMCR
FL
Enumeration date
09/23/2005
Last updated
01/11/2013
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